CAJ | 학술논문

目的观察持续静脉泵入呋塞米与多巴胺联合参麦注射液治疗难治性心力衰竭患者利尿剂抵抗的疗效、可行性及安全性.方法将56例产生利尿剂抵抗的难治性心力衰竭患者按随机数字表法分为对照组及治疗组,每组28例.对照组给予常规利尿剂及常规抗心力衰竭治疗;治疗组在常规抗心力衰竭治疗的基础上持续静脉泵入呋塞米与多巴胺联合参麦注射液,连用5～7 d.比较两组的临床疗效以及心功能指标等方面的变化.结果治疗后治疗组显效10例,有效14例,无效4例,总有效率为85.7%(24/28);对照组显效3例,有效10例,无效15例,总有效率为46.4%(13/28),两组总有效率比较差异有统计学意义(P＜0.05).对照组治疗后左室舒张末期内径(LVEDD)、短轴缩短率(FS)、左室射血分数(LVEF)及心脏指数(CI)与治疗前比较无显著改善(P＞0.05),而治疗组治疗后上述指标均有显著改善(P＜0.05),并且两组治疗后上述指标比较差异也有统计学意义(P＜0.05).治疗组出现低钾、低钠血症2例,经积极补钾、补钠治疗后纠正,未见其他不良反应.结论在常规抗心力衰竭治疗基础上,持续静脉泵入呋塞米与多巴胺联合参麦注射液治疗,对难治性心力衰竭利尿剂抵抗疗效显著,临床安全可行.
목적 관찰지속정맥빙입부새미여다파알연합삼맥주사액치료난치성심력쇠갈환자이뇨제저항적료효、가행성급안전성.방법 장56례산생이뇨제저항적난치성심력쇠갈환자안수궤수자표법분위대조조급치료조,매조28례.대조조급여상규이뇨제급상규항심력쇠갈치료;치료조재상규항심력쇠갈치료적기출상지속정맥빙입부새미여다파알연합삼맥주사액,련용5～7 d.비교량조적림상료효이급심공능지표등방면적변화.결과 치료후치료조현효10례,유효14례,무효4례,총유효솔위85.7%(24/28);대조조현효3례,유효10례,무효15례,총유효솔위46.4%(13/28),량조총유효솔비교차이유통계학의의(P＜0.05).대조조치료후좌실서장말기내경(LVEDD)、단축축단솔(FS)、좌실사혈분수(LVEF)급심장지수(CI)여치료전비교무현저개선(P＞0.05),이치료조치료후상술지표균유현저개선(P＜0.05),병차량조치료후상술지표비교차이야유통계학의의(P＜0.05).치료조출현저갑、저납혈증2례,경적겁보갑、보납치료후규정,미견기타불량반응.결론 재상규항심력쇠갈치료기출상,지속정맥빙입부새미여다파알연합삼맥주사액치료,대난치성심력쇠갈이뇨제저항료효현저,림상안전가행.
Objective To observe the efficacy,feasibility and safety of continous intravenous infusion of furosemide,dopamine combined with Shenmai on treatment of refractory heart failure. Methods Fifty-six patients with diuretic resistance and refractory heart failure were divided into control group(28 patients)and treatment group(28 patients)by random digits table. Conventional diuretics and other anti-heart failure treatment were used in two groups, meanwhile, continuous intravenous infusion of furosemide,dopamine and Shenmai were used in treatment group for 5-7 days. The clinical symptoms and signs, pulmonary edema in chest X-ray and the improvements of pulmonary congestion were observed before and after treatment. Results In treatment group, 10 patients were markedly effective, 14 patients were effective, and 4 patients were unfruitful. The total effective rate was 85.7%(24/28). In control group, 3 patients were markedly effective, 10 patients were effective, and 15 patients were unfruitful. The total effective rate was 46.4%(13/28). There was significant difference in total effective rate between two groups (P ＜ 0.05). The indexes of left ventricular end-diastolic dimension, fractional shortening, left ventricular ejection fraction and cardiac index were significantly improved in treatment group(P ＜ 0.05), but was not significantly improved in control group(P ＞ 0.05). After treatment,2 patients emerged hypokalemia and hyponatremia, after symptomatic treatment,they all recovered. Conclusion Conventional treatment combined with continuous intravenous infusion of furosemide,dopamine and Shenmai in patients with refractory heart failure is markedly effective, feasible and safe.