多巴胺联合速尿持续泵入治疗顽固性心衰中利尿剂抵抗的疗效观察(1)
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[摘要] 目的 探讨持续静脉泵入多巴胺和呋塞米(速尿)对顽固性心衰的疗效。 方法 将58例顽固性心力衰竭患者随机分为观察组和对照组，分别为30例和28例。观察组在常规抗心力衰竭治疗的基础上联合多巴胺和速尿持续静脉泵入，连续应用6 d；对照组常规抗心力衰竭治疗基础上单纯持续静脉泵入速尿。观察两组治疗后临床症状、体征及心功能指标等方面的变化。 结果 观察组临床总有效25例，总有效率为83.3%；对照组临床总有效15例，总有效率为53.6%。两组比较差异有统计学意义(P<0.05);两组治疗后左室射血分数、左室舒张末内径比较，差异均有统计学意义(P均<0.05)。 结论 在常规治疗基础上持续静脉泵入多巴胺和速尿对存在利尿剂抵抗的顽固性心力衰竭疗效显著。
[关键词] 顽固性心力衰竭；多巴胺；呋塞米；利尿剂抵抗
[中图分类号] R587.2 [文献标识码] B [文章编号] 1673-9701(2012)01-080-02
Effect of Dopamine and furosemide continued vein pumping in treatment of patients with diuretic-resistant heart failure： a clinical analysis of 30 cases
CHEN Changchun
Department of Cardiovascular Medicine, China Coal Third Construction Company Workers′General Hospital in Suzhou City of Anhui Province, Suzhou 234000, China
[Abstract] Objective To explore the efficacy of Dopamine and Furosemide continued vein pumping in treatment of refractoriness heart failure. Methods Fifty-eight patients were divided into treatment group with 30 cases and control group with 28 cases. The treatment group was used the Dopamine and Furosemide continued vein pumping, used 3 days, the control group was used Furosemide only. Symptom, sign, the index of heart funditon were analyzed after treatment in two groups. Results The total effective cases in the treatment group was 25 cases(83.3%) ;and the control group was 15cases (53.6%), there was a significant difference between two groups(P<0.05). After treatment the two groups＇ LVEF and LVEDD there was a significant difference (P<0.05). Conclusion On the basis of routine treatment, Dopamine and Furosemide continued vein pumping in treatment of Diuretic-resistant refractoriness heart failure has remarkable curative effects.
[Key words] Refractoriness heart failure; Dopamine; Furosemide; Diuretic-resistant
顽固性心力衰竭是各种心脏疾病发展至终末阶段的一种临床综合征，以慢性、进行性泵功能衰竭和水钠潴留为特征[1,2]。心力衰竭治疗中， 利尿剂是重要的治疗药物，可有效缓解液体潴留，减轻心脏容量负荷， 改善血流动力学。部分患者在治疗过程中会产生利尿剂抵抗，即在尚未达到减轻水肿的治疗目标之前，利尿剂的利尿作用减弱或消失的临床状态[3,4]。笔者对2007年1月～2010年10月本院收治的58例顽固性心力衰竭患者分析其病因，现报道如下。
1 资料与方法
1.1 一般资料
选取 2007 年 1 月～2010 年 10月本院顽固性心力衰竭患者 58例，心功能分级为Ⅲ～Ⅳ级。随机分为两组，观察组和对照组，分别为30例和28例。观察组30例中，男 17 例，女13例，年龄40～79 岁，平均(65.51±6.30)岁，其中高血压性心脏病17例，扩张型心肌病8例 ......
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