持续静脉泵入呋塞米与多巴胺联合黄芪注射液治疗难治性心力衰竭患者利尿剂抵抗

目的观察持续静脉泵人呋塞米与多巴胺并静脉滴注黄芪注射液对难治性心衰患者利尿剂抵抗的疗效、可行性及安全性。方法将47例产生利尿剂抵抗的难治性心衰患者随机分为对照组20例及治疗组27例。对照组采用常规利尿剂及其他抗心衰治疗;治疗组在常规治疗基础上持续静脉泵入呋塞米和多巴胺及静脉滴注黄芪注射液,连用3-5d。观察治疗前、后两组临床症状体征及胸片肺水肿、肺淤血改善情况,以及心功能指标等方面的变化。结果两组治疗后各项观察指标较治疗前都有改善,但治疗组改善更加明显（P〈O．05）,治疗组临床总有效率为85．2％,对照组为45％（P〈0．05）。结论在常规抗心力衰竭治疗基础上,持续静脉泵人呋塞米与多巴胺辅以黄芪注射液静脉滴注对难治性心衰患者利尿剂抵抗疗效显著,临床安全可行。     

呋塞米联合多巴胺治疗利尿剂抵抗性心力衰竭的临床疗效及对水通道蛋白的影响研究

目的探讨呋塞米联合多巴胺治疗利尿剂抵抗性心力衰竭的临床疗效及对水通道蛋白(AQP2)的影响。方法选取2012年5月—2014年8月在重庆市江津区中心医院治疗的利尿剂抵抗性心力衰竭患者96例,按照抽签方式分为对照组和观察组,每组48例。对照组患者给予常规治疗并持续静脉泵入呋塞米,观察组患者在对照组基础上静脉泵入呋塞米和多巴胺,比较两组患者临床疗效及治疗前后心功能指标、24 h尿量、血肌酐及尿AQP2水平。结果观察组临床疗效优于对照组(P0.05)。两组患者治疗前左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、舒张早期心室充盈速度最大值/舒张晚期心室充盈速度最大值(E/A)、24 h尿量、血肌酐及尿AQP2水平比较,差异无统计学意义(P0.05)。观察组患者治疗后LVEF高于对照组,LVEDD小于对照组,24 h尿量大于对照组,尿AQP2水平低于对照组(P0.05);两组患者治疗后E/A、血肌酐水平比较,差异无统计学意义(P0.05)。结论持续静脉泵入呋塞米联合多巴胺可有效改善利尿剂抵抗性心力衰竭患者心功能,减轻利尿剂抵抗,降低尿AQP2水平。     

呋塞米联合多巴胺持续静脉泵入治疗顽固性心力衰竭临床分析

目的:探讨呋塞米联合多巴胺持续静脉泵入治疗顽固性心力衰竭的临床效果。方法:选取50例顽固性心力衰竭患者,随机分为观察组和对照组。常规抗心衰治疗用于两组,对照组同时给予呋塞米持续静脉泵入治疗,观察组同时给予呋塞米联合多巴胺持续静脉泵入治疗,观察两组心功能改善情况。结果:观察组治疗后的左室射血分数高于对照组治疗后的左室射血分数,差异有统计学意义(P<0.05)。观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论:呋塞米联合多巴胺持续静脉泵入治疗能够显著改善顽固性心力衰竭患者心功能,提高治疗效果,值得借鉴。     

持续静脉泵入多巴胺与呋塞米治疗袢利尿剂抵抗难治性心力衰竭30例

目的观察持续静脉泵入多巴胺与呋塞米（速尿）治疗伴利尿剂抵抗难治性心力衰竭的疗效及安全性。方法将60例伴利尿剂抵抗难治性心力衰竭患者随机分为两组。对照组30例采用常规抗心力衰竭治疗，治疗组30例在常规抗心力衰竭治疗的基础上采用持续静脉泵入多巴胺、速尿，连续应用5d。观察治疗前后两组在临床症状、体征及心功能指标等方面的变化。结果两组治疗后左室射血分数、左室舒张末内径较治疗前有改善，但治疗组改善更明显（P〈0．05）。治疗组临床总有效率为83．3％，对照组为46．7％（P〈0．05）。结论在常规抗心力衰竭治疗的基础上采用持续静脉泵入多巴胺、速尿治疗伴利尿荆抵抗难治性心力衰竭病人疗效较显著。     

多巴胺联合呋塞米解除利尿剂抵抗的临床观察

目的:探讨小剂量多巴胺联合低剂量呋塞米持续泵入解除Ⅰ型心肾综合征(CRS)患者利尿剂抵抗的疗效.方法:选择符合慢性心力衰竭(CHF)并具有肾功能不全已出现利尿剂抵抗,符合在心功能Ⅲ～Ⅳ级,肌酐＜442mmol/L范围的患者110例,随机将其分为两组,每组为55例患者.观察组:小剂量多巴胺联合低剂量呋塞米持续泵入;对照组:大剂量呋塞米持续静脉注射.全部患者在入院时均进行心脏超声、胸片、肾功能、心电图及其它临床常规检查.两组患者的发病年龄、心功能分级、肾功能水平、浮肿程度及24 h尿量等情况差异无统计学意义(P＞0.05).记录两组患者症状改善情况、24 h尿量、射血分数EF值、肾小球率过滤(GRF)、住院天数、出院时6 min步行时间情况,统计上述指标是否有统计学意义.结果:两组患者症状均有改善,尿量增加,体重降低,左心室射血分数增加,肾小球率过滤增加,但观察组较对照组改善更明显(P＜0.05).结论:小剂量多巴胺联合低剂量呋塞米持续泵入,可显著提高疗效,解除利尿剂抵抗并且能有效改善心、肾功能,用药安全性高,适用于慢性心力衰竭合并肾功能不全患者利尿剂抵抗治疗.     

早期应用小剂量多巴胺联合呋塞米治疗心力衰竭的有效性及安全性

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124例纽约心脏病学会(NYHA)心功能分级Ⅲ～Ⅳ级的患者,随机分为联合治疗组(62例)和呋塞米组(62例).联合治疗组予静脉持续泵人小剂量多巴胺(0.5～1 μg·kg-1.min-1)联合呋塞米(20～40 mg/d)静脉注射.呋塞米组仅静脉注射呋塞米(20～40 mg/d).观察两组患者住院天数、心功能改善情况、利尿剂抵抗、肾功能恶化、死亡以及血钾、血钠、血压、心率、体重下降、EF值和BNP水平.结果 联合治疗组的住院天数平均为(5.75±1.3)d,显著短于呋塞米组[(8.12±1.1)d](P=0.025).联合治疗组出现利尿剂抵抗和肾功能恶化的患者均显著低于呋塞米组,体重下降、BNP均较对照下降明显(P＜0.05),LVEF升高较对照组明显(P＜0.05).联合治疗组无死亡患者,呋塞米组死亡1例(P＞0.05).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.     

强化利尿并高张盐水在难治性心力衰竭伴低钠血症患者中的疗效观察

目的探讨强化利尿并高张盐水在伴有低钠血症的难治性心力衰竭患者中的疗效。方法收集难治性心力衰竭伴低钠血症患者21例,随机分为11例和10例两组,分别给予1.81%或2.72%高张盐水配合大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉使用,记录两组患者的心功能、尿量、体重及血钠等指标的变化。结果呋塞米并高张盐水组尿量、体重、血钠由治疗前的595ml/24h±163ml/24h、63.9kg±5.8kg和121.1mmol/L±7.3mmol/L变为治疗后的2186ml/24h±256ml/24h、54.2±4.8kg和137.1mmol/L±4.9mmol/L;在尿量增加、体重减轻、血钠恢复正常等方面明显优于单纯呋塞米组。NYHA心功能分级呋塞米并高张盐水组也显著优于单纯呋塞米组。结论难治性心力衰竭伴低钠血症患者使用高张盐水配合强化利尿可有效减轻水钠潴留,改善心脏功能,并有效纠正低钠血症。其机制可能与高张盐水增加有效循环血量,改善肾脏灌注,抑制神经内分泌激活,增加利尿剂在作用部位浓度等有关。     

重组人脑利钠肽对利尿剂抵抗的临床观察

目的:探讨重组人脑利钠肽对利尿剂抵抗心力衰竭患者利尿剂抵抗的影响.方法:入选112例利尿剂抵抗心力衰竭患者,根据指南给予常规药物治疗,入组前48 h给予呋塞米80 mg/d,但24 h尿量＜0.5 mL·kg-1·h-1.将患者分为对照组和治疗组,每组56例.对照组将呋塞米翻倍为160 mg/d;治疗组继续给予呋塞米8...     

呋塞米微量泵持续泵入法治疗终末期心力衰竭患者伴利尿剂抵抗时的疗效分析

心力衰竭是一种复杂的临床症状群,是一种进行性病变,其住院率只占同期心血管病的20%,但死亡率却占40%.心力衰竭进展和恶化时需加大利尿剂剂量,最终导致再大剂量口服和静脉注射呋塞米病人也无反应,呈现利尿剂抵抗.本研究采用呋塞米微量泵持续泵入治疗Ⅲ级～Ⅳ级心力衰竭伴利尿剂抵抗病人以观察临床综合评价指标变化.     

托伐普坦联合呋塞米治疗老年慢性心力衰竭利尿剂抵抗患者的疗效观察

目的观察低剂量托伐普坦联合呋塞米治疗老年慢性心力衰竭(CHF)利尿剂抵抗患者的疗效。方法选择伴利尿剂抵抗的老年CHF患者85例,随机分为观察组(托伐普坦15mg/d口服联合呋塞米40mg/d静脉注射)43例与对照组42例。比较2组治疗前与治疗5d的日均尿量、左心室舒张末容积(LVEDV)变化。结果 2组患者治疗后尿量增加,LVEDV较治疗前降低(P0.05);观察组尿量和LVEDV水平较对照组变化更显著[(2.89±0.87)L/d vs(2.43±0.49)L/d,P=0.01;(103.6±21.5)ml vs(116.7±24.3)ml,P=0.01)]。观察组治疗总有效率高于对照组(86.0%vs 71.4%,P=0.01)。结论联合应用低剂量托伐普坦和呋塞米能有效改善老年CHF患者的利尿剂抵抗,提高临床疗效,值得临床推荐。     

速尿联合多巴胺在慢性心力衰竭治疗中的临床分析

目的观察速尿联合多巴胺在慢性心力衰竭治疗中的作用。方法将84例慢性心力衰竭患者,随机分成治疗组（n=42）和对照组（n=42）分别进行心功能分级和6min步行试验。对照组采用基础治疗（吸氧,半坐卧位,卡托普利、β-受体阻滞剂、螺内酯、地高辛）,治疗组在此之上加用速尿和多巴胺,每天给予多巴胺20-40 mg、速尿20-100 mg加入5%葡萄糖100-250 ml静脉滴注,两组均治疗1个疗程,观察两组治疗后的疗效（心功能改善和6min试验变化情况）。结果与对照组比较,治疗组心功能和6min试验有明显改善,差异有统计学意义（P〈0.01）。结论速尿加多巴胺在慢性心力衰竭治疗中有明显治疗作用。     

Intermittent administration of furosemide vs continuous infusion preceded by a loading dose for congestive heart failure.

Several reports have suggested that continuous intravenous administration of loop diuretics may be superior to intermittent administration. We performed a prospective randomized crossover study comparing intermittent intravenous administration (IA) of furosemide with continuous infusion following a single loading dose (LDCI) in nine patients with severe congestive heart failure. At the time of hospital admission, patients were randomly assigned to one of two treatment groups. One group (four patients) received an IV bolus injection of furosemide followed immediately by a continuous infusion for 48 h. The second group (five patients) was treated with three IV bolus injections a day for 48 h. Total doses of furosemide were equivalent in the two groups. After 48 h, each patient was crossed over to the other method and treated for an additional 48 h. LDCI produced significantly greater diuresis and natriuresis than IA (total urine output increased by 12 to 26 percent, total sodium excretion increased by 11 to 33 percent) (p less than 0.01). There were no significant differences in side effects between the two methods. These results indicate that LDCI may be a preferred method for administration of furosemide in patients with congestive heart failure.     

重组人脑利钠肽治疗失代偿性心力衰竭的临床观察

目的:观察重组人脑利钠肽(rhBNP)治疗失代偿性心力衰竭(DHF)的临床效果。方法:选择心功能分级(NYHA)Ⅲ~Ⅳ级的DHF患者41例,随机分为rhBNP治疗组和对照组硝酸甘油(NIT),观察2组患者治疗前后及治疗后3d生命体征,心功能分级,相关心功能指标及血浆脑利钠肽(BNP)浓度的变化。结果:1.2组治疗前后左心室舒张末期内径(LVDD)无明显变化(P>0·05)。2.患者心率(HR)均明显下降(P<0·05);治疗后3d,rhBNP组HR仍维持较低(P<0·05)。3.治疗后3d内,rhBNP组尿量较NIT组明显增多(P<0·05)。4.患者左心室射血分数(LVEF)均有提高(P<0·05),且rhBNP组升高更明显(P<0·05);治疗后3d,rhBNP组仍有改善(P<0·05)。5.患者NYHA分级均降低(P<0·05);治疗后3d,2组NYHA分级仍较低(P<0·05)。6.治疗后3d,患者血浆BNP水平均有下降(P<0·05),且rhBNP组下降更明显(P<0·05)。结论:rhBNP可明显改善DHF患者的心功能,其近期效果优于常规NIT治疗。     

急性失代偿性心力衰竭患者连续与间歇注射呋塞米的对比研究

目的：比较连续（cIV）或间歇（iIV）静注给予呋塞米对急性失代偿性心力衰竭（ADHF）患者的疗效和安全性的差异。方法纳入2011年6月~2012年11月江苏省南通市海安县南莫中心卫生院ADHF患者56例,其中26例采用cIV方式给药的患者纳入cIV组,30例采用iIV方式给药的患者纳入iIV组,主要终点为每日净尿量（nUOP）,次要终点包括：nUOP/呋塞米、每日总尿量（tUOP）、tUOP/呋塞米、研究过程中的失重、需要的额外急性代偿性心力衰竭治疗、给药的持续时间和住院天数及安全性评估（包括损失的电解质和低血压的发生率）。结果 cIV组患者nUOP和tUOP均高于iIV组[nUOP：（2098±1132）ml vs.（1575±1100）ml,P=0.086;tUOP：（3726±1121）ml vs.（2955±1267）ml,P=0.019],同时tUOP/呋塞米比值也更高[（38.6±31.0）ml/mg vs.（22.2±12.5）ml/mg,P=0.021];其他指标,包括nUOP/呋塞米、研究过程中的失重、需要的额外急性代偿性心力衰竭治疗、给药的持续时间及安全性无差异。cIV组的住院时间比iIV组更短[（6.9±3.7）d vs.（10.9±8.3）d,P=0.006）]。结论cIV方式较iIV方式更有利减轻ADHF患者水钠潴留情况,且患者耐受性良好。     

甘露醇联合多巴胺治疗肝硬化难治性腹水的疗效观察

目的探讨甘露醇联合多巴胺治疗肝硬化难治性腹水的疗效及安全性。方法92例肝硬化难治性腹水患者被随机分为两组,对照组（42例）给予多巴胺40mg,以（0.5～2）μg.kg^-1.min^-1的速度静滴和呋噻米40mg静脉注射,治疗组（50例）给予20%甘露醇250ml、呋噻米40mg静滴和多巴胺40mg,以（0.5～2）μg.kg^-1.min^-1的速度静滴,两组均常规综合治疗。观察患者治疗后的主要症状和体征、每日尿量、腹水的消退情况、并发症及药物不良反应。结果治疗组总有效率（86.0%）高于对照组（61.9%）（P〈0.01）,第1、2周日平均尿量也显著高于对照组（P〈0.01）,治疗后两组血生化及肾功能指标间差异无统计学意义（P〉0.05）,治疗组无明显的药物不良反应。结论甘露醇联合多巴胺治疗肝硬化难治性腹水有较好的疗效和安全性。     

静脉应用速尿的不同方式对充血性心力衰竭疗效的影响

目的：观察静脉泵人与静脉注射速尿治疗中重度充血性心力衰竭（CHF）的临床效果。方法：86例CHF患者被随机分为静脉泵入组与静脉注射组,各43例。两组均给予心衰的基础治疗,静脉泵入组速尿100mg／d,20mg／h持续静脉泵人5h．静脉注射组100mg／d,1次静注。共观察7d,治疗前后测体重、左室射血分数（LVEF）、心输出量（CO）、6min步行距离。结果：静脉泵入组总有效率为88．4％,静脉注射组的79．1％,差异有显著性（P〈0．05）。静脉泵入组体重、LVEF、CO、6min步行距离改善明显优于静脉注射组（P〈0．05）。结论：静脉泵人速尿治疗CHF的疗效优于静脉注射。     

Continuous Infusion Versus Intermittent Boluses of Furosemide in Acute Heart Failure: A Systematic Review and Meta-Analysis

BackgroundAcute heart failure is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute heart failure.MethodsElectronic searches were performed on PubMed, Medline, Scopus, and EMBASE. English articles comparing intermittent boluses and continuous infusion of furosemide in treating acute heart failure were included. Non-comparative studies or articles, and articles that did not report specific data for acute heart failure patients were excluded. Primary endpoints included post-treatment daily urine output, weight, length of stay, and serum sodium, potassium, and creatinine. Secondary endpoints included other pre-treatment and treatment variables. Post hoc trial sequential analysis (TSA) was performed on selected variables.ResultsTen randomized controlled trials were included with a total of 735 patients (371 with intermittent boluses and 364 with continuous infusion). Mean daily urine output (P < .001) and weight loss (P = .04) were significantly higher in the continuous infusion group. Other variables were not significantly different between the two groups. TSA showed that current evidence is sufficient to draw the above conclusions about mean daily urine output, but more studies were required to compare the 2 regimens in terms of weight loss.ConclusionChoice of furosemide regime in acute heart failure remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.     

Effects of standard heart failure therapy and concomitant treatment with intravenous furosemide or inotropes (dobutamine, dopamine, and/or milrinone) on renal function and mortality in patients treated with nesiritide

The safety and efficacy of the concomitant use of intravenous diuretics and positive inotropes with nesiritide have not been well studied. There is also a paucity of data examining whether the type of medical therapy before treatment with nesiritide has an effect on outcomes. Data from 167 patients with heart failure and reduced left ventricular ejection fractions (34 +/- 17%) treated with nesiritide were analyzed retrospectively. Baseline oral medications were continued, diuretic regimens were modified, and nitrates were discontinued. Forty-three patients (26%) received intravenous furosemide with nesiritide. The glomerular filtration rate before and after nesiritide infusion was not different in patients treated with versus without furosemide (0.7 +/- 8.8 vs 0.7 +/- 11.0 ml/min/1.73 m(2), p = 0.71). Change in urine output from before to during nesiritide infusion was greater with concomitant furosemide (41 +/- 57 vs 10 +/- 58 m/hour, p = 0.006). There was no significant difference in survival with furosemide (90% vs 89% at 30 days, 62% vs 57% at 12 months, p = 0.63). Thirty-nine patients (23%) received inotrope support with nesiritide. The glomerular filtration rate tended to improve when inotropes were used with nesiritide (3.3 +/- 13.1 vs -0.1 +/- 9.4, ml/min/1.73 m(2), p = 0.17). No significant changes in serum creatinine or urine output were observed with inotrope use. Survival was not worsened in those receiving inotropes (p = 0.51). Also, there were no significant differences in serum creatinine, glomerular filtration rate, or urine output in patients who continued to receive angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, or digoxin therapy during nesiritide infusion. In conclusion, there were no observed adverse affects of baseline medical therapy, intravenous diuretics, or intravenous inotropes on renal functions or mortality when used in conjunction with nesiritide in the treatment of decompensated chronic heart failure.     

Diuretic Dosing in Acute Decompensated Heart Failure: Lessons from DOSE

The mainstay of treatment for acute decompensated heart failure (ADHF) is intravenous (IV) diuretic therapy either as a bolus or via continuous infusion. Despite being available for decades, few randomized trials exist to guide dosing and administration of these drugs. In 2011, the Diuretic Optimization Strategies Evaluation (DOSE) trial used a prospective, randomized design to compare bolus versus continuous infusion of IV furosemide, as well as high-dose versus low-dose therapy. The study found no difference in the primary end point for continuous versus bolus infusion. High-dose diuretics were more effective than low dose without clinically important negative effects on renal function. Although limited by patient selection criteria and protocol design, the study challenges long-held beliefs that continuous infusion is more effective than bolus dosing. The study also challenges the notion that high-dose diuretics carry clinically important renal toxicity risks for patients.