50%葡萄糖静注联合呋塞米治疗顽固性心力衰竭疗效分析

Effect of 50% Glucose Injection Combined with Furosemide in Treatment of Refractory Heart Failure

目的:探讨50%葡萄糖静注联合持续泵入呋塞米治疗顽固性心力衰竭临床效果。方法:62例顽固性心力衰竭患者随机分成联合治疗组和对照组,每组31例,联合治疗组采取50%葡萄糖100 m L静注联合呋塞米100 mg持续静脉泵入,对照组采取呋塞米300 mg间断注射。记录两组患者临床治疗效果,比较两组患者治疗前后24小时尿量、脑利钠肽、心脏指数(CI)、左心室舒张期前后径(LVEDD)和左室射血分数(LVEF)变化情况。结果:联合治疗组患者临床效果总有效率90.3%,远高于对照组64.5%(P<0.05);治疗后,两组患者24 h尿量均有所增加,BNP浓度均有所减少,差异均具有统计学意义(均P<0.05),联合治疗组患者24 h尿量多于对照组,BNP浓度少于对照组,差异均具有统计学意义(均P<0.05),两组患者CI和LVEF均较治疗前提高(均P<0.05),而LVEDD较治疗前差异无统计学意义(P>0.05),联合治疗组患者CI和LVEF提高程度均高于对照组(均P<0.05)。结论:50%葡萄糖静注联合持续泵入呋塞米治疗顽固性心力衰竭短期临床效果显著,能够明显减少水钠潴留,减轻水肿,改善心脏功能。

Objective： To investigate the clinical effects of 50 % glucose injection combined with continuous pump of furosemide in treatment of refractory heart failure. Methods： 62 cases of patients with refractory heart failure were randomly divided into combined treatment group and control group. Each group had 31 cases. Patents in combined treatment group were taken 50 % glucose 100 mL intravenous combined with 100 mg furosemide continuous intravenous infusion, while in control group were given 300 mg furosemide intermittent injection. The clinical effects of the two groups were recorded. The volume of urine in 24 hours, the concemtration of brain natriuretic peptide （BNP）, cardiac index （CI）, left ventricular diastolic diameter （LVEDD） around and left ventricular ejection fraction （LVEF） changes before and after treatment were compared. Results： The total efficiency rate of patients in combined treatment group was 90.3 %, which was much higher than 64.5 % of the control group （P〈0.05）. After treatment, the volume of 24 h urines of the two groups was increased, while the BNP concentration was reduced, the differences were all statistically significant （P〈0.05）. The volume of 24 h urine in the combined treatment group was more than that of the control group, while BNP concentration was less than that of the control group, the differences were all statistically significant （P〈0.05）. After treatment, the CI and LVEF of patients in the two groups was all increased than before treatment （P〈0.05）, but the LVEDD had no significant difference compared with before treatment （P〈0.05）. The CI and LVEF of patients was much higher in combined treatment group than the control group （P〈0.05）. Conclusions： The short-term clinical effects of 50 % glucose intravenous combined with continuous infusion of furosemide were significant in treatment of refractory heart failure. It could significantly reduce water and sodium retention, reduce swelling and improve heart function.