联合应用托拉塞米与多巴胺对顽固性心力衰竭疗效.docVIP

江苏医药2011年12月第37卷第24期　Jiangsu Med J, December 2011, Vol 37, No.24 联合应用托拉塞米和多巴胺对顽固性心力衰竭的疗效 蒋文龙 郑若龙 崔俊友 易桂斌 陈新军 陶金松 张华 【摘要】目的 观察大剂量托拉塞米联合多巴胺治疗顽固性心力衰竭的临床疗效方法顽固性心力衰竭患者53例分成两组：对照组25例仅给予常规治疗；联合治疗组28例加用大剂量托拉塞米联合多巴胺治疗。治疗5~7d观察患者血压心率尿量肾功能及电解质等改善情况。结果 与对照组比较联合治疗组治疗后心率体重血钾脑钠肽BNP下降尿量血钠6min步行距离增加，纽约心脏病协会NYHA分级改善，水钠潴留明显减轻（P0.05或P0.01）。结论 加用大剂量托拉塞米和多巴胺治疗顽固性心力衰竭具有较好疗效。 【关键词】托拉塞米；多巴胺；心力衰竭 【中图分类号】R541 【文献标识码】A 【文章编号】0253-3685（2011）24-2964-03 Efficacy of combined use of torasemide and dopamine in treatment of refractory heart failure JIANG Wenlong , ZHENG Ruolong, CUI Junyou， et al. Department of Cardiology, Affiliated Jiangyin Hospital, College of Medicine, Southeast University, Jiangyin 214400, CHINA 【Abstract】 Objective To evaluate the efficacy of combined use of torasemide and dopamine in treatment of refractory congestive heart failure(CHF). Methods Fifty three patients with refractory CHF were randomized into two groups of B (25 cases, given conventional treatment alone) and A (given additional intravenous infusion of torasemide plus dopamine twice daily). The treatment lasted for 5 to 7 days. The blood pressure, heart rate, urinary volume, electrolytes and renal function were compared. Results Compared to group B, heart rate, body weight, potassium and brain natriuretic peptide(BNP) were reduced, urinary volume, serum sodium and six-minute walk test were increased after treatment in group A with reduced water-sodium retention and improved NYHA class (P0.05 or P0.01). Conclusion The additional use of high-dose torasemide combined with dopamine is effective in treating refractory CHF. 【Key words】 Torasemide; Dopamine; Heart failure 充血性心力衰竭(CHF)为心脏病科治疗的重点，随着近来药物治疗的不断进展，该病的治疗效果较前明显好转。然而，部分患者即使经洋地黄、利尿剂、血管紧张素转化酶抑制剂、β受体阻滞剂的联合治疗，心功能仍难以纠正，称之为顽固性心力衰竭。近年来心脏再同步化治疗、左室辅助装置、心脏移植等非药物治疗方法的不断创新，顽固性心力衰竭的预后较前明显改善[1]，但是对绝大多数不具备非药物治疗条件的患者，治疗仍然极为棘手。目前，限盐和强有力的利尿剂减轻水钠潴留仍是治疗顽固性心力衰竭的有效方法，我科在常规药物治疗的基础上加用多巴胺及托拉塞米，对顽固性心力衰竭取得了较好的临床疗效，报道如下。 资料与方法 一、一般资料 选择我院2007年8月～2010年12月顽固性心力衰竭患者53例，男33例，女20例，年龄45