慢性肺源性心脏病右心衰竭患者中利尿剂的使用

目的研究慢性肺源性心脏病患者心功能失代偿期利尿剂使用问题,确定利尿脱水过程中失液量/总血容量的耐受低限。方法选择2008-10至2013-10间呼和浩特市第一医院慢性肺源性心脏病急性加重期患者17例进行回顾性调查,当患者发生了过度利尿导致的低血压事件(收缩压90mmHg,脉压20mmHg,脉率收缩压)时,排除其他影响心率和血压的因素后,搜集其一般情况、体重、利尿剂使用情况、出入量平衡状况、休克指数(脉搏/收缩压)等资料。由患者体重和出、入量差值得出脱水量所占血容量百分比,研究失液比例与休克指数间的关系,以失液比例为自变量,以休克指数为因变量,对其做线性相关与回归分析。结果本研究显示我院慢性肺源性心脏病心功能失代偿期患者病因构成、病史、住院时间、合并症、病死率等指标与大多数资料报道相近,但利尿剂使用不规范问题确实存在。由统计分析结果可知,在过度利尿导致的低血压事件时该类患者失液比例与休克指数呈高度线性正相关(r=0.802),最佳线性拟合方程即Y=0.49+3.92X,相关检验过程中均显示P?,证明上述线性相关关系以及最佳线性拟合方程成立。结论慢性肺源性心脏病患者急性发作期能否尽早控制/清除肺部感染病灶决定着患者的预后。慢性肺源性心脏病患者心功能失代偿时,利尿剂种类宜选弱效利尿剂,监控患者日出入量。当失液比例13%,应引起管床医师警惕;若失液比例达到23.6%,应立即予以补液维持循环血容量,防止休克进一步发展。

The use ofdiuretic in patients with chronic pulmonary heartdisease on the stage of right heart failure

Abstracts Objective By foensing on the use of diuretic in patients with chronic pulmonary heap disease on the stage of right heart failure, we want to confirm the lower limit of dehydration volume/total blood volume which these patients can bear aider usifig diiaetie. Methods We collect the data of 17 patients with chronic pulmonary hearf disease on the stage of fight heart failure who had t6 be hospitalized in our hospital in past five years to conduct retrospective study. The data which consist of the situation of these patients、 weight, the use of diuretic、 the balance of their body fluid input and output、 shock index etc. would be collected when an episode of blood pressure dropping because of using diuretic at will happened （systolic blood pressure〈90mmHg, difference of blood pressure〈20mmHg, pulse rate〉systolic blood pressure）. Of course, we do this after excluding all other factors. And then, we can get the proportion of dehydration volume/total blood volume by computing these patients body weight and the difference of their body fluid input and output, study the relationship of the proportion of dehydration volume/total blood volume and the shock index. Finally we do linear correlation and regression analysis between the proportion of dehydration volume/total blood volume taken as independent variables and the shock index taken as dependent variables. Results ARer investigation we find that many norm such as cases、 medical history、 length of hospital stay. complications、 mortality etc. meet with lots of other similar report about patients with chronic pulmonary heart disease on the stage of right＇beart failure, moreover the fact using diuretic at will exist during all the treatment. The statistic results show that in this case the relationship of the proportion of dehydration volume/total blood volume and the shock index is highly linear correlation when an episode of blood pressure dropping because of using diuretic at will happened, it＇s the best linear fitting equation ~=0.49＋3.92X, related statistical test confirm all of them （P 〈 a ）. Conclusion For patients with chronic pulmonary heart disease on the stage of right heart failure if clearing lung infection as soon as possible or not determine that they survive or die when their basic disease acute attack. When the patients with chronic pulmonary heart disease be on the stage of right heart failure, doctors should choice weak diuretic to reduce the edema, control the difference of their body fluid input and output. If the proportion of dehydration volume/total blood volume〉 13%, doctors should beware; If the proportion of dehydration volume/total blood volume run up to 23.6%, doctors should transfuse balance solution for them rapidly in order to prevent the disease developing from bad to worse.