呋塞米联合多巴胺持续静脉泵入治疗利尿剂抵抗性心力衰竭的效果观察

The efficacy of continuous intravenous infusion Furosemide combined Dopamine in treatment for heart failure patients with diuretic resistance

目的:观察呋塞米联合多巴胺持续静脉泵入治疗利尿剂抵抗性心力衰竭的效果及其对患者水通道蛋白2(AQP2)的影响。方法:选取2018年5月—2020年8月宁夏回族自治区人民医院收治的96例利尿剂抵抗性心力衰竭患者,采用随机数字表法分为对照组和观察组各48例。对照组给予常规治疗,以166.7μg/min的速度持续静脉泵入呋塞米,观察组在对照组的基础上,以1.5~2.5μg/(kg·min)的速度泵入多巴胺,8~10 h/d,连续治疗7 d。比较两组患者治疗后临床疗效、心功能指标、尿量、血清肌酐、尿AQP2变化。结果:治疗后,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者左室射血分数(LVEF)较治疗前明显升高,左室舒张末期内径(LVEDD)较治疗前降低,E/A较治疗前升高,差异有统计学意义(P<0.05);观察组LVEF高于对照组,LVEDD低于对照组,差异有统计学意义(P<0.05);治疗后,观察组E/A水平与对照组比较,差异无统计学意义(P>0.05)。治疗后,两组尿量明显多于治疗前,且观察组尿量多于对照组,差异有统计学意义(P<0.05);两组血肌酐水平与治疗前比较无显著差异,观察组肌酐水平与对照组比较,差异无统计学意义(P>0.05);与治疗前比较,两组尿AQP2明显降低,差异有统计学意义(P<0.05),但观察组的尿AQP2水平与对照组比较,差异无统计学意义(P>0.05)。结论:利尿剂抵抗性心力衰竭患者持续性静脉泵入呋塞米联合多巴胺,可显著改善患者心功能,减轻利尿剂抵抗现象,降低尿水通道蛋白水平。

Objective To investigate the efficacy of Furosemide and Dopamine continuous intravenous in treatment for heart failure patients with diuretic resistance,and the effect on aquaporin 2(AQP2).Methods 96 cases of heart failure patients with diuretic resistance from May 2018 to August 2020 for the treatment in People’s Hospital of Ningxia Hui Autonomous Region were selected;They were divided into control group and observation group by method of random numbers table,48 cases in each group.Patients in the control group were treated with conventional therapy,166.7μg/min speed continuous intravenous furosemide,the observation group on the basis of the control group,1.5-2.5μg/(kg·min)the speed of the pump into dopamine,8-10 h/d,continuous treatment for 7 d.The clinical efficacy of the patients after treatment,cardiac function,urine,serum creatinine,urine AQP2 change was compared.Results The total effective rate in the observation group was higher than those in control group(P<0.05);The LVEF after treatment in two groups were significantly higher than that before treatment,LVEDD were lower(P<0.05),E/A were higher than that before treatment(P<0.05),LVEF in observation group was higher than that in control group,LVEDD was lower than that in control group(P<0.05),the difference of E/A level in two group was not statistically significant(P>0.05);The urine volume was significantly increased in two groups,the degree of urine to improve in the observation group was higher than the control group(P<0.05),serum creatinine levels were lower in two group,there was no difference in the degree of improvement creatinine;Urinary AQP2 decreased in both groups compared with that before treatment,the degree of improvement in urinary AQP2 in the observation group was higher than that in the control group(P>0.05).Conclusion It shows that continuous intravenous infusion of Furosemide and Dopamine in treatment of heart failure patients with diuretic resistance can significantly improve cardiac function,reduce diuretic resistance phenomenon,and reduce urinary aquaporin levels.