大剂量呋塞米持续静脉泵入对早期急性肾损伤伴急性肺水肿的临床疗效

目的 研究大剂量呋塞米持续静脉泵入对早期急性肾损伤伴急性肺水肿的临床疗效。方法 选择2012年2月~2015年12月在陕西省人民医院进行诊治的早期急性肾损伤伴急性肺水肿患者180例，所有患者均先持续静脉泵入1~2 mg/min呋塞米，再按照患者尿量的多少调整呋塞米的用药剂量。分别在治疗前和治疗后6、12、24、48、72 h，观察并记录患者的血肌酐、血尿素氮、氧合指数、血钾、机械通气时间、pH值、预后情况和不良反应发生情况。结果 呋塞米用药剂量开始减少的时间平均为（12.15±3.12）h；呋塞米的应用时间平均为（46.31±4.89）h；治疗后各时间点患者的血肌酐、血尿素氮、氧合指数、pH值和血钾均与治疗前有明显差异（P<0.05），且治疗后各时间点上述观察指标均有明显差异（P<0.05）；180例患者中，治疗后有161例肾功能恢复，占89.44%，呼吸困难的症状得到明显减轻，X线胸片发现肺水肿有明显好转，成功停止机械通气，机械通气时间平均为（35.28±11.37）h；在治疗过程中，180例患者血流动力学稳定，均未出现低血压、耳聋和耳鸣等不良反应。结论 给予大剂量呋塞米治疗早期急性肾损伤伴急性肺水肿，能明显增加尿量，改善肾功能、内环境紊乱和预后，提高救治成功率。

Clinical effect of high-dose cefuroxime continuous intravenous pumping for early acute renal injury accompanied by acute lung edema

Objective To investigate the clinical effect of high-dose cefuroxime continuous iv pumping on early acute renal injury accompanied by acute lung edema. Methods Selected 180 cases of patients with early acute renal injury accompanied by acute lung edema who were treated in Shanxi Provincial People''s Hospital from January 2012 to December 2015. All patients were treated with 1-2 mg/min furosemide continuous infusion, the amount of furosemide was adjusted according to a target urine output. The serum creatinine, blood urea nitrogen, oxygenation index, potassium, mechanical ventilation time, pH, prognosis and adverse reactions before and after treatment 6, 12, 24, 48, and 72 h were observed and recorded. Results Cefuroxime dosage began to decrease at the average time point of (12.15±3.12) h; The average application time was (46.31±4.89) h; Compared with before treatment, serum creatinine, blood urea nitrogen, oxygen and index, pH and potassium at each time point after treatment have obvious difference (P<0.05), and each time point after treatment had significant difference (P<0.05); After treatment, 161 cases had renal function recovery, accounted for 89.44%, the symptoms of dyspnea, X-ray chest radiograph had improved markedly, successful stop mechanical ventilation; The average mechanical ventilation time was (35.28±11.37) h; In the process of treatment, 180 cases of patients with stable hemodynamics, all did not appear adverse reactions such as deafness and tinnitus. Conclusion Using high-dose cefuroxime to treat early acute renal injury accompanied by acute lung edema can obviously increase urine output, improve renal function, disorder of internal environment and prognosis, and improve the successful rate.