呋塞米联合酚妥拉明治疗新生儿呼吸衰竭疗效观察

目的:探讨呋塞米联合酚妥拉明对新生儿呼吸衰竭的疗效。方法:血气分析及X线资料完整的226例新生儿呼吸衰竭患儿随机双盲分成对照组和实验组,实验组在对照组病因治疗和供氧治疗的基础上加用甲磺酸酚妥拉明0.5 mg/kg,1次/6 h,视病情逐渐延长间隔时间,直至停药,同时予小剂量呋塞米0.2 mg/(kg.d)静脉注射。治疗前和治疗24 h后对两组血气分析差值进行比较。结果:治疗24 h后血气分析结果显著改善,两组比较差异均有统计学意义(P<0.01)。结论:呋塞米联合酚妥拉明治疗新生儿呼吸衰竭效果好,针对病情较重的患儿宜及早使用。     

呋塞米治疗支气管哮喘疗效观察

目的观察雾化吸入呋塞米（速尿）治疗支气管哮喘的临床疗效。方法 95例喘息性支气管炎患者分成治疗组50例和对照组45例。对照组给予吸氧、氨茶碱、沙丁胺醇、地塞米松等综合治疗,治疗组在对照组基础上给予超声雾化吸入呋塞米20～30mg。观察2组临床疗效。结果治疗组有效率为98.0%高于对照组的73.3%,差异有统计学意义（P〈0.05）。结论在综合治疗基础上联合雾化吸入呋塞米治疗支气管哮喘疗效显著。     

呋塞米治疗支气管哮喘临床疗效

呋塞米俗称速尿，目前常用于治疗各种原因引起的水肿。本文就目前常用支气管哮喘药物的疗效与呋塞米进行比较发现，呋塞米治疗哮喘患者总有效率高，在与山莨菪碱联用时，效果更加明显，且不良作用少，为哮喘治疗提供了新的治疗模式。     

呋塞米的少见不良反应

本文根据近年来国内外有关呋塞米的不良反应的文献报道,概述了呋塞米的少见不良反应,有些不良反应比较严重,应予以重视.     

早期应用小剂量多巴胺联合呋塞米治疗心力衰竭的疗效

目的观察早期应用小剂量多巴胺联合呋塞米治疗心功能Ⅲ～Ⅳ级心力衰竭的有效性及安全性。方法入选美国纽约心脏病学会心功能分级Ⅲ～Ⅳ级的患者124例,随机分为2组:联合治疗组和呋塞米组(均62例)。呋塞米组,仅静脉注射呋塞米(20～40 mg.d-1);联合治疗组,除静脉注射相同剂量呋塞米外还静脉持续泵入小剂量多巴胺(0.5～1.0μg.kg-1.min-1)。观察2组治疗前后血清钾与钠、血压、心率、体重、左室射血分数(LVEF)、B型尿钠肽(BNP)的变化及住院天数和肾功能恶化程度,并判断疗效。结果联合治疗组与呋塞米组,平均住院天数分别为(5.75±1.30),(8.12±1.10)d(P=0.025)。出现利尿剂抵抗和肾功能恶化的患者,联合治疗组均显著低于呋塞米组;体重、BNP的下降与LVEF升高,联合治疗组较对照差异均有统计学意义(均P<0.05)。联合治疗组的总有效率明显优于呋塞米组(95.2%vs 77.42%,P<0.05)。仅呋塞米组死亡1例。结论早期应用小剂量多巴胺联合呋塞米对心功能Ⅲ～Ⅳ级心力衰竭患者的疗效优于单独用呋塞米。     

呋塞米加重哮喘

1名50岁女性慢性喘息性支气管炎患者,因下肢水肿给予呋塞米20mg静脉滴注后,出现严重呼吸困难,面部、口唇发绀。经吸氧、抗过敏及对症治疗后缓解。追问病史,患者数年前曾因水肿静脉滴注利尿药后出现过类似症状。     

早期使用呋塞米在足月新生儿重度窒息复苏后治疗中的临床观察

目的观察早期使用呋塞米在足月新生儿重度窒息复苏后治疗中的效果。方法将我院2006年1月至2010年1月出生及治疗的98例重度窒息复苏后的足月新生儿,分为治疗组50例、对照组48例。治疗组在常规治疗基础上早期给予呋塞米治疗;对照组仅给予常规治疗,出现颅内高压症状时才给予降低颅内压治疗。结果治疗组在治疗过程中临床表现为缺氧缺血性脑病(HIE)的发生率48.0%,头颅CT分度为中、重度缺氧缺血性脑病的发生率8.0%;而对照组则分别为68.8%和22.9%,两组比较差异有统计学意义(P<0.05)。结论早期使用呋塞米治疗重度窒息复苏后的足月新生儿,可预防和减少新生儿缺氧缺血性脑病的发生,值得临床进一步推广和应用。     

早期应用呋塞米（速尿）预防早产儿肺透明膜病的临床观察

目的 探索早产儿肺透明膜病（ＨＭＤ）的预防措施。方法 收治９５例早产儿，随机分为两组，观察组５３例，对照组４２例，观察组在综合治疗的基础上加用速尿。结果 观察组ＨＭＤ的发生率（１．８％）明显低于对照组（１６．７％），Ｐ〈０．０５。结论 速尿可减少ＨＭＤ的发生。     

地高辛与呋塞米联合治疗慢性心力衰竭的疗效观察

目的探讨地高辛联合呋塞米治疗慢性心力衰竭患者的临床疗效与安全性。方法将2011年2月至2013年2月收治的100例慢性心力衰竭患者,根据随机原则分为对照组与观察组,每组50例。对照组给予卡普托利+卡维地洛+呋塞米进行治疗,观察组在对照组的基础上加用地高辛。治疗3个月后,对2组患者的疗效、心率、血压以及不良反应进行观察与记录。结果观察组的总有效率显著高于对照组,差异有统计学意义(P<0.05);治疗3个月后,观察组的心率、舒张压和收缩压均显著低于对照组,差异均有统计学意义(P<0.05);观察组的总体不良反应发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论地高辛联用呋塞米治疗慢性心力衰竭疗效显著,不良反应少,值得临床推广。     

白蛋白联合呋塞米治疗脑出血临床疗效分析

目的:探讨白蛋白联合呋塞米治疗脑出血的临床疗效。方法:选取2011年1月—2013年1月110例脑出血患者,随机分为观察组与对照组。对照组采用常规治疗,观察组在此基础上加用白蛋白联合呋塞米治疗,对比分析两组疗效。结果:治疗后观察组血肿吸收情况明显优于对照组(P<0.05),差异有统计学意义;治疗后观察组美国国立卫生研究院卒中量表(NIHSS)评分明显低于对照组(P<0.05);观察组乳酸、C反应蛋白(CRP)、丙二醛(MDA)明显低于对照组(P<0.05),差异有统计学意义;观察组超氧化物歧化酶(SOD)明显高于对照组(P<0.05),差异有统计学意义。结论:白蛋白联合呋塞米治疗脑出血能有效促进机体神经功能恢复,促进血肿吸收,同时能有效减轻机体炎症反应,减轻氧化应激损伤,减轻脑出血后继发损伤。     

新生儿湿肺的临床及X线表现

目的探讨新生儿湿肺的X线表现,以提高正确诊断率。方法分析在2006～2009年间收治的78例新生儿湿肺病例的临床表现及X线表现。结果全部病例均有呼吸增快,其中皮肤发绀42例,呻吟34例,听诊全部病例均有呼吸音增粗,有湿啰音21例;X线表现为肺泡积液64例;间质积液53例,肺血管充血28例;肺气肿25例。结论新生儿湿肺的临床及X线表现有一定特点,结合临床表现及胸部平片X线表现可确诊。     

新生大鼠肺组织石蜡包埋的适宜条件

目的:探索新生大鼠肺组织蜡块制作的合适条件。方法:取20只出生5天的新生大鼠肺组织进行固定、脱水、浸蜡、包埋。结果:新生大鼠肺组织适宜的包埋条件为:①4%甲醛固定液固定18～24h;②65%的酒精和4%的甲醛固定液1:1体积的液体中浸泡(12～24h);③70%酒精里浸泡(12～24h)后进行本文结果中的包埋程序可得到较高质量的新生大鼠肺组织石蜡切片。结论:通过细致的摸索过程可以得到新生大鼠肺组织的适宜包埋条件。     

甘露醇联合速尿治疗肝硬化腹水临床观察

目的：观察甘露醇联合速尿治疗肝硬化腹水与白蛋白联合速尿治疗肝硬化腹水的疗效差异。方法：135例肝硬化患者按入院次序随机分为甘露醇组和白蛋白组。甘露醇组每日静脉滴注20％甘露醇250ml加速尿20mg;白蛋白组每日静脉滴注白蛋白10g加速尿20mg,疗程为5～7d。结果：两组疗效及腹水消退时间的比较无统计学意义。结论：甘露醇联合速尿是治疗肝硬化腹水的一种经济可行的方法。     

托拉塞米与呋塞米治疗创伤性脑水肿的临床对比观察

目的观察托拉塞米与呋塞米在治疗创伤后重型颅脑损伤后脑水肿的临床疗效及颅内压、电解质变化。方法将我科2010年9月到2011年9月收住的80例颅脑损伤引起脑水肿患者完全随机分为托拉塞米组和呋塞米组,各40例。在维生素水、电解质及酸碱平衡,清除自由基,脑保护等治疗基础上,托拉塞米组患者给予托拉塞米20mg加入0．9％氯化钠注射液10ml静脉推注,呋塞米组患者给予呋塞米20mg＋20％甘露醇125ml静脉推注。2组均1次／6h,然后根据病情变化随时调整剂量。疗程均为14d。观察用药前后颅内压的变化,同时观察尿量增加程度和临床疗效。结果托拉塞米组总有效率明显高于呋塞米组[92．5％（37／40）比62．5％（25／40）,P〈0．05]。2组治疗第1天始,尿量即开始增加,用药第1～7天,患者尿量均高于用药前,差异有统计学意义（P〈0．05）。用药第2～7天,托拉塞米组患者尿量均明显高于呋塞米组[（3489±291）ml比（3389±271）ml,（3716±431）ml比（3509±321）ml,（3869±372）ml比（3609±328）ml,（3815±429）ml比（3689±151）ml,（3792±341）ml比（3709±311）ml,（3787±411）ml比（1699±621）ml,均P〈0．05]。用药第1～7天,托拉塞米组患者颅内压均明显低于呋塞米组[（17．9±1．1）mmHg（1mmHg=0．133kPa）比（18．3±1．0）mmHg,（16．7±0．9）mmHg比（17．9±0．7）mmHg,（15．9±0．6）mmHg比（17．1±0．5）mmHg,（15．5±0．7）mmHg比（16．6±1．3）mmHg,（14．8±0．6）mmHg比（15．8±0．9）mmHg,（14．8±0．7）mmHg比（15．4±1．5）mmHg,（14．3±0．8）himHg比（15．7±0．8）mmHg,均P〈0．05]。托拉塞米组电解质紊乱发生率明显低于呋塞米组[7．5％（3／40）比20．0％（8／40）,P〈0．05]。结论托拉塞米治疗创伤性脑水肿可明显降低颅内压,增加尿量,提高疗效。     

静脉泵入与静脉注射速尿治疗重度充血性心力衰竭的疗效比较

目的通过比较静脉泵入与静脉注射速尿（呋塞束）治疗重度充血性心力衰竭（congestive heart failure，CHF）的临床效果．为充血性心力衰竭的治疗提供新的方法。方法50例重度心力衰竭患者被随机分为静脉泵入组与静脉注射组，各25例。两组均给予心力衰竭常规治疗，静脉泵入组速给予速尿100mg·d^-1，10mg·h^-1持续静脉泵入10h。静脉注射组给予速尿100mg·d^-1，2次静脉注射。7天后观察治疗前后患者临床表现及左室射血分数（left ventricular ejection fraction．LVEF）、心输出量（cardiac output，CO）、心搏量（stroke volume，SV）、心脏指数（cardiac index，CI）的变化。结果静脉泵入组总有效率为92％．静脉注射组的68％，差异有显著性（P〈0．05）。静脉泵入组LVEF、CO、SV、CI改善明显优于静脉注射组（P〈0．05）。结论静脉泵入速尿治疗重度心力衰竭的疗效明显优于静脉注射。     

Influence of intestinal efflux pumps on the absorption and transport of furosemide

Purpose

Furosemide is a commonly used diuretic which is used in the treatment of edema, congestive heart failure, hypertension and renal failure. Its absorption exhibits inter- and intra-subject variability that can be attributed to many factors including the intestinal efflux pumps such as the P-glycoprotein (P-gp). This study was done due to the great disagreement between what is published in the literature regarding the influence of P-gp on furosemide and at the same time due to the importance of this drug in the treatment of different conditions as described above. In addition, an investigation of the effect of two of the commonly used pharmaceutical excipients (hydroxypropyl β-cyclodextrin [HPβCD] and Tween 80) and also a P-gp inhibitor (verapamil hydrochloride) on the intestinal absorption of this drug were also done.

Methods

The study utilized the everted intestinal sacs technique to investigate both the effect of the efflux transporter (P-gp) on furosemide absorption and also the effect of the chosen excipients.

Results

The absorption of furosemide was significantly influenced by the P-gp as confirmed by the everted vis the non-everted sacs together with the verapamil study in which the transport of furosemide was inhibited by verapamil. In addition, Tween 80 was also shown to inhibit the P-gp pump whereas the HPβCD did not significantly influence the efflux of furosemide in this study.

Conclusions

P-glycoprotein and some of the used excipients in the formulation play a very important role in the transport of furosemide and other drugs. Thus excipients that affect the activity of P-gp should be avoided when formulating drugs that are substrate for the P-gp or other efflux pumps.     

Pharmacokinetics of furosemide in gestosis of pregnancy

Summary Furosemide 50 mg was administered orally and intravenously to twelve gestotic women for brief periods as a part of a randomized, multicentre clinical trial comparing the efficacy of bed rest and pharmacological treatment. The pharmacokinetic profile was investigated using a gas-liquid chromatographic technique. The plasma half-life after oral and intravenous administration was 115±37.1 and 71.8±26.3 min and plasma clearance was 153±48 and 152±23 ml/min, respectively (mean±SD). Comparative data from healthy pregnant women cannot be obtained for ethical reasons. The results show that gestosis has only a marginal if any effect on the kinetics of furosemide in comparison with published kinetic parameters in healthy volunteers and patients with renal failure. The new-born babies where checked for side effects according to a protocol in use in a larger regional surveillance programme. No clinical side-effects were attributable to furosemide, but the small size of the group does not permit any definitive conclusions about this aspect.     

On the fate of furosemide in man

Summary ³⁵S-furosemide was administered orally (n=7) or i.v. (n=2) to healthy subjects. The average gastrointestinal uptake estimated by comparison of the urinary recovery of label and the areas under the plasma curves after the two routes of administration was 65%. The half life of radioactivity in the plasma after oral³⁵S-furosemide was 90 ± 17 min (estimated on the slope between 2 and 6 h); the corresponding figure after³⁵S-furosemide i.v. was 47–53 min (slope 0.5–4 h). There was probably a slower phase after 4–6 h. Fractionation of labelled material in urine from two subjects demonstrated that approximately two thirds of the label recovered at 24 h had the same chromatographic properties as furosemide. A major part of the metabolite(s) was probably furosemide glucuronide. There was no evidence that 4-chloro-5-sulfamoylanthranilic acid was formed in man. The total urinary recovery of label (5–7 d) after oral and intravenous administration was 55.1±3.2 (mean±SD) and 82–84%, respectively. After³⁵S-furosemide i.v., 6–9% of the label was recovered in faeces, and it could not be accounted for solely by biliary excretion of furosemide.     

Bioavailability of seven furosemide tablets in man

A seven-way crossover study was conducted in 14 healthy male volunteers to evaluate the relative bioavailability of seven different marketed 40 mg furosemide tablets. Each dose was administered as a single tablet after an overnight fast, and blood samples were obtained for 16 hours. Plasma was assayed by HPLC. There were no statistically significant differences among the seven products for the mean peak concentration (1.01-1.29 micrograms/ml), mean time of peak (1.2-2.1 h) or mean area under the plasma concentration-time curves, which differed by less than 14 per cent. However, one product exhibited greater intersubject variability, and on this basis was considered inequivalent to the other six products. Furosemide is a potent and widely used diuretic. Currently the United States Food and Drug Administration (USFDA) has granted approval to at least twelve manufacturers of 40 mg furosemide tablets, based in part on bioavailability data obtained in human subjects. In addition, the USFDA has granted an 'AB' therapeutic equivalence evaluation to each of these products, which is understood by many to indicate the therapeutic equivalence and interchangeability of these products. The objective of the present investigation was to directly compare the bioavailability of seven 40 mg furosemide tablet products which had previously been approved by the Food and Drug Administration.     

Dose-dependent pharmacokinetics of furosemide in the rat

The pharmacokinetics of furosemide were investigated in the rat at doses of 10 and 40mg kg^?1 corresponding to doses of 80 and 320 mg given to humans based on body surface area. A three-compartment open model with renal excretion taking place from the shallow peripheral compartment gave the best fit to the data. The terminal half-life of furosemide was found to change from 29min for the 10 mg kg^?1 dose to 49min for the 40 mg kg^?1 dose. This change could be detected as a change in the apparent volume of distribution caused by decreased protein binding at increasing plasma concentrations of furosemide. The total plasma clearance did not change significantly although metabolic and renal clearances both changed. The renal clearance was found to be dependent on the free fraction of furosemide in plasma and thus increased with increasing plasma concentrations. The metabolic clearance decreased with increasing dose indicating a saturable metabolism of furosemide.