吸入呋塞米对支气管哮喘病人气道反应性的影响

目的 :探讨吸入呋塞米对支气管哮喘 (哮喘 )病人气道反应性的影响。方法 :缓解期哮喘病人4 0例 ,随机分为A ,B 2组 ,每组各 2 0例。试验分 2次隔日交叉吸入 0 .9%氯化钠注射液 4mL或呋塞米 4 0mg后予组胺吸入激发试验。结果 :2组病人吸入 0 .9%氯化钠注射液后的组胺PC2 0 FEV1差异无显著意义 (P >0 .0 5) ;吸入呋塞米后的组胺PC2 0 FEV1差异亦无显著意义 (P >0 .0 5) ;但 2组病人吸入呋塞米后的组胺PC2 0 FEV1均显著高于其吸入0 .9%氯化钠注射液后的组胺PC2 0 FEV1(均P <0 .0 5)。结论 :吸入呋塞米可抑制哮喘病人的气道高反应性。     

Synchronous Changes in Active and Inactive Renin Secretion after Furosemide in Patients with Primary Aldosteronism

Changes in plasma active and inactive renin concentrations (ARC and IRC) were measured in 10 patients with primary aldosteronism (PA) due to adrenal adenomas. Before the resection of adrenal adenomas, venous blood samples were taken at supine resting state, after 1-hour standing and 30 min. after furosemide injection and these samplings were repeated after surgical treatment. Plasma inactive renin was measured after activation with trypsin. Before the treatment ARC and IRC did not change by standing or furosemide. After the treatment, however, ARC was increased clearly by standing or furosemide, and IRC was also increased by furosemide injection. Both ARC and IRC at supine resting state were increased after the surgery. When the renin-angiotensin system is suppressed chronically by the over-produced aldosterone in patients with PA, not only active but also inactive renin secretions are suppressed, and fail to respond to orthostasis or furcsemide. The secretion of IR could be stimulated after the removal of aldosteronoma.     

Influence of prophylactic furosemide on arrhythmias in acute myocardial infarction -- a controlled study

In a prospective controlled study the frequency of arrhythmiasduring the early phase of acute myocardial infarction (AMI)was evaluated in 73 consecutive patients randomly assigned toeither high or low dose furosemide prophylaxis. The high dosegroup (HDG) received 120 mg and the low dose group (LDG) 20mg furosemide i.v. during the initial 24 hours in hospital.Increased diuresis, haemoconcentration and augmented heart rateswere found in the HDG. No electrolyte disorders separated thegroups. Hypokalemia was seen in two HDG patients and in oneLDG patient on admission, and in two and three patients respectivelyafter 24 hours. Continuous ECG recordings at a paper speed of10 mm s^–1 were obtained from all patients. Two patientsin the HDG had ventricular fibrillation, none in the LDG. Thenumber of patients with various arrhythmias was not significantlydifferent in the two groups. Supraventricular tachyarrhythmiaswere more common in the HDG, whereas ventricular tachycardiaand ventricular extrasystoles were seen more often in the LDG.We conclude that heart rate and recurrence of tachyarrhythmiasin AMI may be influenced by furosemide therapy, seemingly throughmechanisms other than electrolyte imbalance.     

Haemodynamic effects of high or low doses of furosemide in acute myocardial infarction

The haemodynamic effects of high or low doses of furosemideused to prevent overt left heart failure (LHF) in acute myocardialinfarction (AMI) were studied. Fifteen consecutive AMI patientswithout overt LHF and with a cardiac index (CI) of 2.6 +0.51min^–1 m^–1, a right atrial mean pressure (RAMP) of7±3 mmHg and a pulmonary arterial diastolic pressure(PADP) of 14±4 mmHg were investigated during 24 h. Ahigh dose group (HDG) received 40 mg furosemide t.i.d. and alow dose group (LDG) 20 mg once daily. Following the first 40 mg of furosemide (HDG), the stroke volumeindex (SVI), CI, RAMP and PADP decreased. The heart rate andsystemic vascular resistance index (SVRI) increased. Followingthe first 20 mg of furosemide (LDG), the only significant changewas a decrease in PADP. After 24 h, the heart rate in the HDG was further increased;the SVI, RAMP and PADP were further reduced, whereas CI wassimilar to that before. In the LDG, the heart rate, SVI andCI remained unchanged. All pressures tended to decline and theSVRI was lower than in the HDG. Thus, repeated injections of 40 mg of furosemide induced a sustainedpreload reduction in AMI patients without overt LHF, but thiswas associated with potentially disadvantageous haemodynamicfindings.     

小剂量呋塞米联合呼气末正压在老年食管癌根治术中的应用效果

目的观察小剂量呋塞米联合呼气末正压(PEEP)对老年食管癌根治术患者血流动力学和氧合的影响。方法择期全身麻醉下行食管癌根治术患者33例,随机分为呋塞米组(A组)、呋塞米+PEEP组(B组)和对照组(C组)。缝合膈肌时A组给予呋塞米0.2 mg/kg,B组给予呋塞米0.2 mg/kg并将PEEP调至5 cm H_2O。观察各组麻醉前(T_0)、麻醉诱导插管(T1)、拔管后即刻(T_2)及拔管后15 min(T_3)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)和氧合指数[p(O_2)/FiO_2]的变化。结果 A组和B组的拔管时间显著短于C组(P0.05)。C组在T_2、T_3时的CVP显著高于A组和B组(P0.05)。A组和B组的p(O_2)/FiO_2在T2、T3时显著高于C组(P0.05),而B组的p(O_2)/FiO_2在T_2、T_3时又显著高于A组(P0.05)。结论小剂量呋塞米联合使用PEEP可改善老年食管癌根治术患者的氧合情况,缩短拔管时间。     

A Randomized Controlled Trial of a Single Dose Furosemide to Improve Respiratory Distress in Moderate to Severe Bronchiolitis

Background

Bronchiolitis is one of the most common disorders of the lower respiratory tract in infants. While historically diuretics have been used in severe bronchiolitis, no studies have looked directly at their early use in children in the emergency department.

Absence of tolerance and toxicity to high-dose continuous intravenous furosemide in haemodynamically unstable infants after cardiac surgery

What is already known about this subject

• Continous i.v. infusion of furosemide is superior to intermittent administrations, especially in haemodynamically unstable infants, because it results in a more controlled diuresis (although doses are generally chosen rather low).

What this study adds

• High-dose continuous furosemide infusion is an effective treatment for volume overload in haemodynamically unstable infants.
• Development of tolerance to furosemide was not observed despite high doses and prolonged exposure.
• Maximum serum furosemide concentrations remained well below the presumed toxic concentration.

Aim

To evaluate a high-dose continuous furosemide regimen in infants after cardiac surgery.

Methods

Fifteen haemodynamically unstable infants with volume overload admitted to a paediatric intensive care unit were treated with an aggressive furosemide regimen consisting of a loading bolus (1–2 mg kg⁻¹) followed by a continuous infusion at 0.2 mg kg⁻¹ h⁻¹ which was adjusted according to a target urine output of 4 ml kg⁻¹ h⁻¹. Frequent sampling for furosemide concentrations in blood and urine was done for 3 days with simultaneous assessment of sodium excretion and urine output.

Results

The mean furosemide dose was 0.22 (± 0.06), 0.25 (± 0.10) and 0.22 (± 0.11) mg kg⁻¹ h⁻¹ on the first, second and third day, respectively. Median urine production was 3.0 (0.6–5.3), 4.2 (1.7–6.6) and 3.9 (2.0–8.5) ml kg⁻¹ h⁻¹, respectively, on the first, second and third day of the study. The target urine production was reached at a median time of 24 (6–60) h and this was maintained during the study period. The regimen did not result in toxic serum concentrations and was haemodynamically well tolerated.

Conclusion

High-dose continuous furosemide infusion for 72 h in haemodynamically unstable infants after cardiac surgery appears to be a safe and effective treatment for volume overload. Development of tolerance against the effects of furosemide and ototoxic furosemide concentrations were not observed.     

呋塞米吸入治疗支气管哮喘急性发作28例临床观察

目的评价呋塞米（速尿）吸入对支气管哮喘的治疗效果。方法 28例支气管哮喘发作患者随机分为治疗组和对照组,分别给予呋塞米、赋形剂吸入治疗,每组各14例。两组同时均接受哮喘常规治疗。结果治疗组总有效率（有效＋显效）为92.86%,优于对照组（78.57%）,P〈0.05。结论呋塞米吸入治疗对支气管哮喘急性发作有效。     

呋噻米不同使用方法对肾病综合征患儿的利尿作用

目的探讨持续静脉滴注呋噻米和静脉注射呋噻米后持续静脉滴注维持对肾病综合征水肿患儿的利尿效果。方法采取自身对照方法,选择原发肾病综合征患儿20例,应用2种给药方式,观察给予呋噻米后12h患儿尿量及尿钠、钾、氯、肌酐排泄量的变化,并进行比较。同时观察患儿在治疗过程中有无不良反应。结果在给予静脉滴注呋噻米后最初6h,患儿尿量明显增高。静脉注射呋噻米后持续静脉滴注维持的患儿在最初6h中,其尿量及尿钠、钾、氯的排泄量均比单纯持续静脉滴注呋噻米者增加,但只有尿钠、尿氯增高有显著性（P〈0．05）。治疗过程中,未发现不良反应。结论持续静脉滴注呋噻米对肾病综合征水肿患儿利尿效果安全、有效,之前给予呋噻米静脉注射可提高利尿效果。