硝普钠联合多巴胺治疗急性心力衰竭的临床观察

Clinical Observation of Nitroprusside Combined with Dopamine in the Treatment of Acute Heart Failure

目的：观察硝普钠联合多巴胺治疗急性心力衰竭（AHF）的临床疗效和安全性。方法：96例AHF患者随机均为对照组和研究组。两组患者均给予血管紧张素转化酶抑制剂类药物、地高辛、利尿药、他汀类药物、阿司匹林等常规治疗;在此基础上,对照组患者给予注射用硝普钠12.5~25.0 mg,加入5%葡萄糖注射液50 ml中,以6.25μg/min微量泵入后,根据血压情况,以12.5~50.0μg/min维持泵入;研究组患者在对照组治疗的基础上给予盐酸多巴胺注射液100 mg,加入5%葡萄糖液50 ml中,以2μg/（kg·min）泵入,后以2~10μg/（kg·min）维持泵入。两组患者疗程均为5~7 d。观察两组患者的临床疗效,治疗前与治疗0.5、3、12、24、48 h后血流动力学指标（中心静脉压、肺动脉收缩压、心率、心排血量指数）,治疗前与治疗24、48、72 h后肾功能指标（血钾、血钠、血尿素氮、血肌酐、24 h尿量）及不良反应发生情况。结果：研究组患者总有效率显著高于对照组,差异有统计学意义（P〈0.05）。治疗后,两组患者各时间点中心静脉压、肺动脉收缩压、心率、血钾、血钠均显著低于同组治疗前,心排血量指数、血尿素氮、血肌酐、24h尿量均显著高于同组治疗前,差异均有统计学意义（P〈0.05）;但治疗后两组患者各时间点的血流动力学、肾功能指标比较,差异均无统计学意义（P〉0.05）。两组患者不良反应发生率比较,差异无统计学意义（P〉0.05）。结论：在常规治疗的基础上,硝普钠联合多巴胺治疗AHF较单用硝普钠疗效更显著,可明显降低心脏负荷、增加心排量、改善肾功能,且安全性相当。

OBJECTIVE：To observe the clinical efficacy and safety of nitroprusside combined with dopamine in the treatment of acute heart failure（AHF）. METHODS：96 patients with AHF were randomly divided into control group and research group. All patients were given ACEIs,digoxin,diuretics,statins,aspirin and other conventional treatment. On this basis,control group was given nitroprusside 12.5-25.0 mg,adding into 5% Glucose solution 50 ml by micro pump and started at 6.25 μ g/min,and then maintained at 12.5-50.0 μg/min based on the blood pressure adjustment;research group was given dopamine 100 mg based on the treatment of control group,adding into 5% Glucose solution 50 ml at rate of 2 μg/（kg·min）by pump,and maintained at 2-10 μg/（kg·min）. The course of both was 5-7 d. The clinic data was observed,including clinical efficacy,hemodynamic parameters（central venous pressure,pulmonary artery systolic pressure,heart rate and cardiac output index）before and 0.5,3,12,24 and 48 h after treatment,renal functions（serum potassium,blood urea nitrogen,serum creatinine and 24 h urine）before and 24,48 and 72 h after treatment,and the incidence of adverse reaction. RESULTS：The total effective rate in research group was significantly higher than control group,with significant difference（P〈0.05）. The central venous pressure,pulmonary artery systolic pressure,heart rate,serum sodium and potassium in 2 groups at different time points were significantly lower than before;cardiac index,blood uric acid nitrogen,creatinine and 24 h urine were significantly higher than before,with significant difference（P〈0.05）. However,there were no significant differences on the hemodynamic parameters and renal functions at different time points between 2 groups（P〉0.05）. There were no significant differences in the incidence of adverse reactions（P〈0.05）. CONCLUSIONS：Nitroprusside combined with dopamine has more obvious efficacy than only nitroprusside in the treatment of AHF,and can obviously reduce the cardiac stress,increase cardiac output and improve renal function,with similar safety.