大剂量速尿持续静脉输入治疗高龄严重心衰患者的护理

The nursing of high-dose,continuous intravenous infusion of furosemide as a therapy for elderly patients with severe heart failure

目的:探讨大剂量速尿持续静脉输入治疗高龄严重心衰患者的效果观察及护理要点。方法:将患严重心衰的60例高龄患者随机分为治疗组及对照组,对照组予以ACEI(或ARB)、地高辛、硝酸酯类等药物,间断静脉(或口服)使用速尿(约40～80mg/日),治疗组在应用ACEI(或ARB)、地高辛、硝酸酯类等药物的基础上,24h持续静脉泵入速尿(约160～300mg/日),短期治疗5天,治疗期间监测两组患者血压、心率、尿量,观察两组患者心衰症状的缓解情况,并监测治疗组电解质、肾功能、尿酸等指标,指导其饮食、体位,控制输液速度,加强床边监测及护理。结果:与对照组相比,治疗组的心衰症状有明显改善、尿量明显增多,在严密监测、控制速尿泵入速度、及时补充电解质及密切的护理下,短期内大剂量速尿持续静脉输入未引起低血压、严重的电解质紊乱,亦未见肾功能恶化,虽然尿酸有所升高,但在饮食指导下,未引起痛风的发作。结论:在加强床边护理及监测情况下,短期大剂量速尿持续静脉泵入治疗高龄严重心衰患者,可有效改善患者心衰症状,并可减少相关副反应的发生。

Objective It is to study the efficacy and nursing feature of high-dose,continuous intravenous infusion of furosemide as a therapy for elderly patients with severe heart failure.Methods 60 elderly patients with severe heart failure were randomly divided into treatment group and control group.All the patients were treated with ACEI(or ARB),digoxin and nitrates.On this basis,the control group was given furosemide administered intravenously by means of either a bolus(or oral administration) every 12 hours at a regular dose(40 ～80mg/d),and the treatment group was given furosemide by continuous infusion at a high dose(160 ～300mg/d).After 5 days'treatment,the improvement of CHF symptoms in both groups were observed and the changes of urine volume were observed to explore its efficiency,and the renal function,electrolyte,uric acid and ototoxicity of the patients receiving continuous diuretic infusion therapy were determined to explore this therapy's safety.The diet and body position of the patients were directed,the infusion speed was controlled,and the bedside monitor and care were intensified.Results Compared with the control group,the symptoms and urinary volume of treatment group were improved greatly.With careful monitor,controlling the infusion speed,supplying the electrolyte timely,and effective nursing,high-dose,continuous Ⅳ infusion of furosemide was successful in providing diuresis in 5 days without causing hypotension or aberrations in electrolyte and renal function.Though the blood uric acid was higher,the gout attack in treatment group was not found with the diet guidance.Conclusion With the bedside monitor and care intensified,high-dose,continuous Ⅳ infusion of furosemide can effectively improve heart failure symptoms,and the bedside monitor and care can also reduce the relevant side effect.