急性失代偿性心力衰竭患者连续与间歇注射呋塞米的对比研究

Comparison in continuous or intermittent intravenous injections of furosemide in patients with acute decompensated heart failure

目的：比较连续（cIV）或间歇（iIV）静注给予呋塞米对急性失代偿性心力衰竭（ADHF）患者的疗效和安全性的差异。方法纳入2011年6月~2012年11月江苏省南通市海安县南莫中心卫生院ADHF患者56例，其中26例采用cIV方式给药的患者纳入cIV组，30例采用iIV方式给药的患者纳入iIV组，主要终点为每日净尿量（nUOP），次要终点包括：nUOP/呋塞米、每日总尿量（tUOP）、tUOP/呋塞米、研究过程中的失重、需要的额外急性代偿性心力衰竭治疗、给药的持续时间和住院天数及安全性评估（包括损失的电解质和低血压的发生率）。结果 cIV组患者nUOP和tUOP均高于iIV组[nUOP：（2098±1132）ml vs.（1575±1100）ml，P=0.086；tUOP：（3726±1121）ml vs.（2955±1267）ml，P=0.019]，同时tUOP/呋塞米比值也更高[（38.6±31.0）ml/mg vs.（22.2±12.5）ml/mg，P=0.021]；其他指标，包括nUOP/呋塞米、研究过程中的失重、需要的额外急性代偿性心力衰竭治疗、给药的持续时间及安全性无差异。cIV组的住院时间比iIV组更短[（6.9±3.7）d vs.（10.9±8.3）d，P=0.006）]。结论cIV方式较iIV方式更有利减轻ADHF患者水钠潴留情况，且患者耐受性良好。

Objective To discuss the curative effects of continuous intravenous injection （cIV） or intermittent intravenous injection （iIV） of furosemide in the patients with acute decompensated heart failure （ADHF）. Methods The patients with ADHF （n=56） were chosen from the Nanmo Health Center, Hai’an County of Nantong City of Jiangsu Province from Jun. 2011 to Nov. 2012, and then divided into cIV group （n=26） and iIV group （n=30）. The primary end point was net urine output （nUOP）/24 h, and secondary end points included nUOP/furosemide, total urine output （tUOP）/24 h, tUOP/furosemide, weight loss during the study, additional treatment for ADHF, continuing time of drug administration, hospitalization days and safety reviewing （electrolyte loss and hemodynamic instability）. Results The levels of nUOP and tUOP [nUOP：（2098±1132） mL vs. （1575±1100） mL, P=0.086;tUOP：（3726± 1121） mL vs. （2955±1267） mL, P=0.019], and tUOP/furosemide [（38.6±31.0） mL/mg vs. （22.2±12.5） mL/mg, P=0.021] were higher in cIV group than those in iIV group. The other indexes, including nUOP/furosemide, weight loss during the study, additional treatment for ADHF, continuing time of drug administration, and safety had no differences between two groups, and average body weight had no significant difference in two groups before and after treatment. The hospitalization time was shorter in cIV group than that in iIV group [（6.9±3.7） vs. （10.9±8.3 days）, P=0.006]. Conclusion cIV has better curative effect than iIV on the clinical symptoms such as anhelation in ADHF patients, and patients’ tolerance is higher.