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目的观察小剂量多巴胺联合呋塞米治疗重度心力衰竭的临床疗效。方法选取凉山彝族自治州第二人民医院收治的重度心力衰竭患者218例,采用信封法分为对照组(n=73)、小剂量组(n=72)和大剂量组(n=73)。在常规抗心力衰竭治疗基础上,对照组患者仅给予呋塞米治疗,小剂量组患者给予小剂量多巴胺(2μg·kg~(-1)·min~(-1))联合呋塞米治疗,大剂量组患者则给予大剂量多巴胺(5μg·kg~(-1)·min~(-1))联合呋塞米治疗。比较3组患者治疗前后心功能指标[包括左心室射血分数(LVEF)、心功能指数、左心室舒张末期容积、左心室收缩末期容积]、血压、心率、血电解质(血钠、血钾)及血清脑利钠肽(BNP)水平,计算体质量下降值、临床治疗有效率、临床治疗显效率并记录住院时间、并发症发生情况、死亡情况。结果治疗前3组患者LVEF、心功能指数、左心室舒张末期容积、左心室收缩末期容积比较,差异无统计学意义(P>0.05);治疗后3组患者患者LVEF、心功能指数、左心室舒张末期容积、左心室收缩末期容积比较,差异有统计学意义(P<0.05)。治疗前3组患者收缩压、舒张压、心率比较,差异无统计学意义(P>0.05);治疗后3组患者收缩压、舒张压比较,差异有统计学意义(P<0.05),而3组患者心率比较,差异无统计学意义(P>0.05)。3组患者体质量下降值比较,差异有统计学意义(P<0.05)。治疗前后3组患者血钠、血钾及血清BNP水平比较,差异无统计学意义(P>0.05);治疗后3组患者血钠、血钾比较,差异无统计学意义(P>0.05),而血清BNP水平比较,差异有统计学意义(P<0.05)。3组患者住院时间、临床治疗有效率、病死率比较,差异无统计学意义(P>0.05);小剂量组患者肾功能恶化发生率低于对照组和大剂量组,小剂量组和大剂量组患者利尿剂抵抗发生率低于对照组,临床治疗显效率高于对照组(P<0.05)。结论小剂量多巴胺联合呋塞米治疗重度心力衰竭可减少大剂量多巴胺或仅用呋塞米治疗所致不良反应,临床疗效较好。
Objective To observe the clinical efficacy of low-dose dopamine combined with furosemide in patients with severe heart failure. Methods A total of 218 patients with severe heart failure admitted to Second People ’s Hospital of Liangshan Yi Autonomous Prefecture were enrolled and divided into control group (n = 73), low dose group (n = 72) and high dose group (n = 73) by envelope method. On the basis of routine anti-heart failure treatment, the control group received only furosemide, and the low-dose group received low-dose dopamine (2 μg · kg -1 · min -1) combined with furosemide. Large dose group was given high-dose dopamine (5μg · kg -1 · min -1) combined with furosemide treatment. The cardiac function indexes (including left ventricular ejection fraction, cardiac function index, left ventricular end-diastolic volume and left ventricular end-systolic volume), blood pressure, heart rate, blood electrolytes (serum sodium and serum potassium) And serum brain natriuretic peptide (BNP) levels were calculated, the decline in body weight, clinical treatment efficiency, clinical effective rate was recorded and recorded in hospital time, complications, and death. Results There were no significant differences in LVEF, cardiac function index, left ventricular end-diastolic volume, and left ventricular end-systolic volume between the three groups before treatment (P> 0.05). After treatment, LVEF, cardiac function index, left ventricular Diastolic volume, left ventricular end-systolic volume, the difference was statistically significant (P <0.05). There was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the three groups before treatment (P> 0.05). The systolic blood pressure and diastolic blood pressure in the three groups after treatment were significantly different (P <0.05) Group heart rate, the difference was not statistically significant (P> 0.05). Three groups of patients with decreased body weight, the difference was statistically significant (P <0.05). There were no significant differences in serum sodium, serum potassium and serum BNP levels between the three groups before and after treatment (P> 0.05). There was no significant difference in serum sodium and potassium between the three groups after treatment (P> 0.05) The serum BNP levels, the difference was statistically significant (P <0.05). There was no significant difference in hospitalization time, clinical treatment efficiency and mortality between the three groups (P> 0.05). The incidence of renal dysfunction in the low-dose group was lower than that in the control group and the high-dose group, the low-dose group and the high-dose The incidence of diuretic resistance was lower in the patients than in the control group, and the effective rate of clinical treatment was higher than that of the control group (P <0.05). Conclusion Low-dose dopamine combined with furosemide in the treatment of severe heart failure can reduce high-dose dopamine or furosemide-induced adverse reactions, the clinical effect is better.