多巴胺联合呋塞米解除利尿剂抵抗的临床观察

Clinical Observation of Diuretic Resistance Relieved by Dopamine and Furosemide in the Patients with Cardiorenal Syndrome

目的：探讨小剂量多巴胺联合低剂量呋塞米持续泵入解除I型心肾综合征（CRS）患者利尿剂抵抗的疗效。方法：选择符合慢性心力衰竭（CHF）并具有肾功能不全已出现利尿剂抵抗，符合在心功能Ⅲ～Ⅳ级，肌酐〈442mmol／L范围的患者110例，随机将其分为两组，每组为55例患者。观察组：小剂量多巴胺联合低剂量呋塞米持续泵人；对照组：大剂量呋塞米持续静脉注射。全部患者在人院时均进行心脏超声、胸片、肾功能、心电图及其它临床常规检查。两组患者的发病年龄、心功能分级、肾功能水平、浮肿程度及24h尿量等情况差异无统计学意义（P〉0．05）。记录两组患者症状改善情况、24h尿量、射血分数EF值、肾小球率过滤（GRF）、住院天数、出院时6min步行时间情况，统计上述指标是否有统计学意义。结果：两组患者症状均有改善，尿量增加，体重降低，左心室射血分数增加，肾小球率过滤增加，但观察组较对照组改善更明显（P〈0．05）。结论：小剂量多巴胺联合低剂量呋塞米持续泵入，可显著提高疗效，解除利尿剂抵抗并且能有效改善心、肾功能，用药安全性高，适用于慢性心力衰竭合并肾功能不全患者利尿剂抵抗治疗。

OBJECTIVE： To explore the effects of diuretic resistance relieved by the lowdose dopamine companied with furose- mide in the patients with cardiorenal syndrom. METHODS： 110 patients with chronic heart failure and renal dysfunction and diuretic resistance （Cardiac function grade Ⅲ～Ⅳ, creatinine 〈 442mmol/L） were selected. They were randomly divided into observation group （ n = 55 ） and control group （ n = 55 ）. Observation group received low - dose dopamine and furosemide. Control group accept- ed high - dose continuous intravenous furosemide. Cardiac ultrasound, chest, renal function, ECG and other clinical routine exami- nation were dove in all patients. There were no statiscally differences in two groups in age, cardiac function, renal function, edema degree and 24 hours urine volume （P 〉 0. 05 ）. Their symptoms improvement, 24 hours urine output, ejection fraction EF values, glomerular filtration rate GRF, the number of days of hospitalization, discharge 6 minutes walking time, were recorded in two groups. RESULTS： In two groups the patients＇ symptoms were improved, urine output increased, weight decreased, left ventrieular ejection fraction increased and glomerular filtration rate increases. But the indexes above in observation group were improved more significantly than those in control group （P 〈 0. 05）. CONCLUSION ： Low - dose dopamine and low dose continuous infusion of furosemide can significantly improve the efficacy, relieve diuretic resistance, improve heart and kidney function and have the effects in the trentment of chronic heart failure campanied with diuretics in the patients with renal insufficiency resistant.