早期应用小剂量多巴胺联合呋塞米对合并体液潴留心力衰竭的治疗价值

Therapeutic effect of early low dose dopamine combined with furosemide on patients with heart failure

目的观察早期应用小剂量多巴胺联合呋塞米治疗心力衰竭的疗效。方法入选255例纽约心脏病学会(NYHA)心功能分级Ⅲ～Ⅳ级的患者,随机分为联合治疗组(128例)和呋塞米组(127例)。联合治疗组予静脉泵持续泵入小剂量多巴胺(2～3μg·kg-1.min-1)联合呋塞米(20～40mg/d)静脉注射。呋塞米组仅静脉注射呋塞米(20～40mg/d)。观察两组患者的冠状动脉性心脏病监护病房(CCU)住院天数(即心力衰竭改善所需时间)以及出现利尿剂抵抗、需要超滤或血液透析治疗、肾功能恶化和死亡患者的构成。结果联合治疗组的CCU住院天数平均为(3.75±1.20)d,显著短于呋塞米组的(4.13±1.54)d(P=0.030)。联合治疗组出现利尿剂抵抗和肾功能恶化的患者构成比(2.3%和8.6%例)均显著低于呋塞米组(21.3%和26.8%例,P值均=0.000)。联合治疗组有1例患者需要超滤或血液透析治疗,呋塞米组为6例(P>0.05)。联合治疗组无死亡患者,呋塞米组死亡4例(P>0.05)。结论早期应用小剂量多巴胺联合呋塞米可加强心力衰竭患者对呋塞米的治疗反应,及时有效改善体液潴留和心力衰竭症状,保护脏器功能。

Objective To observe the clinical efficacy of early low dose of dopamine combined with furosemide in treatment of patients with severe heart failure. Methods A total of 255 patients with Newyork Heart Association （NYHA） class III and class IV were enrolled in the present study and were randomized into two groups. Dopamine group included 128 patients who were given low dose of dopamine （2-3 μg·kg-1·min-1） combined with intravenous furosemide（20-40 mg/d）; diuretic group included 127 patients who received furosemide（20-40 mg/d）. Coronary care unit （CCU） stay,the incidence of diuretic resistance,dialysis,worsening of renal failure and causes of death were observed. Results CCU stays were （3.75±1.20） days and （4.13±1.54） days （P=0.030） in the dopamine group and diuretic group,respectively. Three patients in the dopamine group and 27 patients in the diuretic group showed diuretic resistance （P=0.000）. Worsening of renal failure occurred in 11 cases in the dopamine group and 34 cases in the diuretic group （P=0.000）. One patient in the dopamine group and 6 patients in diuretic group needed dialysis treatment （P0.05）. There was no death in the dopamine group and there were 4 death cases in the diuretic group （P0.05）. Conclusion Early use of low dose dopamine combined with furosemide can improve the symptoms of patients with heart failure more effectively in shorter time through reducing the fluid retention.