前列地尔联合托拉塞米治疗顽固性心力衰竭的临床研究

Clinical study on alprostadil combined with torasemide in the treatment of intractable heart failure

目的观察前列地尔联合托拉塞米治疗顽固性心力衰竭的近期疗效。方法对经常规抗心力衰竭治疗效果不佳的30例顽固性心力衰竭患者予以前列地尔及托拉塞米治疗，前列地尔20mg加入5％葡萄糖或0．9％氯化钠100ml静脉滴注1次／d；托拉塞米20-40mg静脉注射2次／d；托拉塞米用3d后根据病情调整用量，其余常规抗心力衰竭治疗不变。疗程1周。观察治疗前后患者的血压、体质量、尿量、血肌酐、电解质、N-末端脑钠肽前体（NT-pmBNP）及左心室射血分数（LVEF）的变化。结果治疗后，所有患者呼吸困难、水肿、肺部干湿性哕音等临床症状均明显好转，治疗中3例患者出现轻度低钾血症，经及时补钾得以纠正。治疗后体质量与治疗前比较降低[（63．8±7．6）kg比（82．6±10．7）kg]，尿量与治疗前比较升高[（2328．3±367．8）ml／d比（568．7±104．6）ml／d]，差异均有统计学意义（P〈0．01）；而治疗前后收缩压、舒张压比较差异无统计学意义（P〉0．05）。治疗后LVEF与治疗前比较升高[（44．5±8．3）％比（31．9±10．2）％]，血肌肝水平与治疗前比较降低[（97．8±18．6）μmol／L比（143．8±21．7）μmol／L]，差异有统计学意义（P〈0．05）；治疗后NT—proBNP水平与治疗前比较降低[（567．4±212．3）ng/L比（2726．5±525．3）ng／L]，差异有统计学意义（P〈0．01）.结论前列地尔联合托拉塞米治疗顽固性心力衰竭，能快速有效改善症状，有助于心肾功能的改善，且无明显不良反应发生。

Objective To observe the short-term effect of alprostadil combined with torasemide in the treatment of intractable heart failure. Methods Thirty cases of patients with intractable heart failure and ineffective in routine therapy were given alprostadil and torasemide treatment,with alprostadil 20 mg in 5% glucose or 0.9% sodium chloride solution 100 ml intravenous infusion once a day and torasemide 20 - 40 mg intravenous twice a day 3 days later torasemide dosage was adjusted according to the disease, and the remaining conventional anti-heart failure therapy unchanged. Course was one week. The blood pressure, body weight, urine output, creatinine, electrolytes, N-terminal pro-brain natriuretic peptide （NT-proBNP） and left ventricular ejection fraction （LVEF） before and after treatment was observed. Results After treatment, clinical symptoms of dyspnea, edema, pulmonary rales, such as wet and dry significantly improved in all patients. During the course of the treatment ,3 patients appeared mild hypokalemia,and potassium was promptly corrected. Body weight after treatment reduced compared with that before treatment [（63.8 ± 7.6） kg vs. （82.6 ± 10.7） kg], urine output increased after treatment compared with that before treatment [（2 328.3 ±367.8） ml/d vs. （568.7 ± 104.6） ml/d],and the differences were statisticallysignificant （P 〈 0.01 ）. Systolic blood pressure, diastolic blood pressure difference was not statistically significant after treatment, compared with that before treatment （P 〉 0.05）. LVEF after treatment increased compared with that before treatment [ （44.5 ± 8.3 ）% vs. （31.9 ± 10.2）% ], serum creatinine levels reduced [ （97.8 ± 18.6） μ mol/L vs. （ 143.8 ± 21.7 ） μ mol/L ], and the difference was statistically significant （P 〈 0.05） ; NT-proBNP after treatment reduced compared with that before treatment [ （567.4 ± 212.3） ng/L vs. （2 726.5± 525.3 ） ng/L ], and the difference was statistically significant（P 〈 0.01 ）. Conclusion Alprostadil combined with torasemide treatment can quickly and effectively improve symptoms and help improve heart and kidney function in intractable heart failure, and has no significant adverse reactions.