持续静脉滴注速尿治疗充血性心力衰竭随机对照研究

A randomized-controlled study on continuous furosemide infusion in the treatment of patients with congestive heart failure

目的 探讨持续静脉滴注速尿治疗充血性心力衰竭 (CHF)的药效学及对生理平衡的影响是否优于一次性注射治疗。方法 采用随机对照方法将 70例 NYHA心功能 — 级 CHF患者分为持续静脉滴注组 (静滴组 ,35例 )和一次性静脉注射组 (静注组 ,35例 ) ,静滴组在注射 10 mg负荷剂量速尿后持续静滴 30 m g,静注组一次性注射 4 0 mg,均持续 3日。治疗前后分别评价心功能及血生化指标 ,并计算每日尿量和尿 K+、Na+、Cl-排泄量。结果 静滴组每日尿量及尿K+、Na+、Cl-排泄量均明显大于静注组 ,尤其在治疗的第二日、第三日 ,治疗后静注组除血脂浓度升高比静滴组更显著外 ,其他生化指标两组无显著差异。结论 持续静脉滴注速尿治疗 CHF在药效学方面明显优于静脉注射方式 ,并可提高肾脏对速尿的敏感性 ,延缓耐受性的产生。对生理平衡的影响也可能优于一次性静脉注射 ,值得进一步探讨。

Objective To assess the pharmacodynamic and physiological effects of continuous furosemide infusion compared with IV bolus injection in the treatment of patients with congestive Heart failure (CHF). Methods 70 patients with CHF(NYHA classes Ⅲ Ⅳ) were randomized assigned to one of two groups. One group (35 patients) were preceded by IV bolus injection of loading dose of 10mg furosemide followed immediately by a continuous infusion for 30mg .Another group (35 patients) were treated with IV bolus injections of 40mg furosemide.The treatment period in two groups were 3days .The information of heart function classes and blood physiochemical index were determined before and after treatment, the urinary volume, urinary K +,Na +,Cl - excretion for 24hours were collected everyday. Results The urinary volume, urinary K +?Na +?Cl - excretion for 24hours were significantly greater after treatment with continuous furosimide infusion than that of IV bolus injection, especially in second and third day. Except increased blood lipid levels were significantly greater after treatment with IV bolus injection than that of continuous infusion, other blood physiochemical changes showed no differences.Conclusion The pharmacodynamic of continuous furosemide infusion in the treatment of CHF is significantly better than IV bolus injection, this method increased renal sensitivity to furosemide, and delayed tolerance to forosemide diuresis. The physiological effects of continuous furosemide injection are probably better than in bolus injection. Further investigation is varranted.