利尿剂在慢性肺源性心脏病合并右心衰、Ⅱ型呼吸衰竭中的应用时机探讨

Application timing of diuretic for chronic pulmonary heart disease complicated with risht heart failure and type Ⅱ respiratory failure

目的探讨利尿剂在慢性肺源性心脏病合并有心衰、Ⅱ型呼吸衰竭中的应用时机及效果。方法80例慢性肺源性心脏病合并右心衰、Ⅱ型呼吸衰竭患者随机分为两组各40例，一组为感染未控制组，均给予常规低流量给氧、抗感染、祛痰、解痉、平喘治疗，这组病人再分为治疗组和对照组各20例，其中治疗组加用速尿20mg／次，1次／日，常规予补钾；另一组为感染控制组，即入院后通过抗感染，把感染已控制的患者再随机分为治疗组和对照组各20例，其中治疗组加用速尿20mg／次，1次／日，常规予补钾：测定治疗前后的氧分压、二氧化碳分压。结果感染控制组治疗组无论是氧分压还是二氧化碳潴留改善情况都优于对照组，治疗前后PCO2分别为（64．25±8．54）mmHg、（59．81±7．52）mmHg，治疗前后P02分别为（64．14±7．84）mmHg、（69．24±7．8）mmHg，（P〈0．05）；但感染未控制组刚好相反，治疗前后PCO2分别为（74．97±9．54）mmHg、（80．12±9．82）mmHg，治疗前后P02分别为（61．99±7．81）mmHg、（57．01±7．72）mmHg，差异有显著性（P〈0．05）。结论慢性肺源性心脏病合并Ⅱ型呼吸衰竭应用利尿剂应在感染控制后应用，否则只会加重病情。

Objective To investigate the timing and effects of the diuretic used for chronic pulmonary heart disease（ CPHD ） complicated with right heart failure and type Ⅱ respiratory failure, Methods 80 patients with CPHD complicated with right heart failure and type Ⅱ respiratory failure were randomly divided into uncontrolled infection group（ n=40, treated for normal therapy ） and controlled infection group （ n=40, treated for anti-infective therapy ）. These two groups were respectively divided into treatment group （ n=20, added the furosemide 20mg, qd, and supplemented potassium ） and control group（ n=20 ）, then partial pressure of oxygen（ PO2 ） and partial pressure of carbon dioxide（ PCO2 ） were measured before and after the treatment. Results The improvement of anaerobic condition and carbon dioxide retention were both significantly better in controlled infection group with furosemide treatment than control group, before and after the treatment PCO2 （ mmHg ） were （ 64.25± 8.54 ） and （ 59.81 ± 7.52 ） respectively, before and after treatment PO2 （ mmHg ） were （ 64.14 ± 7.84 ） and （ 69.24 ± 7.8 ） （ P〈 0.05 ） respectively, however, the contrary results were shown in uncontrolled infection group, before and after the treatment PCO2 （ mmHg ） were （ 74.97±9.54 ）and （ 80.12±9.82 ） respectively, before and after treatment PO2 （ mmHg ） were （ 61.99±7.81 ） and （ 57.01±7.72 ） （ P〈 0.05 ） respectively. Conclusion The diuretic should be applied for the patients with CPHD complicated with type Ⅱ respiratory failure after infection controlled, otherwise it would aggravate the disease.