Mojtahedzadeh Mojtaba, Salehifar Ebrahim, Vazin Afsaneh, Mahidiani Hanieh, Najafi Atabak, Tavakoli Maria, Nayebpour Mohsen, Abdollahi Mohammad
Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Infus Nurs. 2004 Jul-Aug;27(4):255-61. doi: 10.1097/00129804-200407000-00011.
Positive fluid balance in critically ill patients is a common problem in the intensive care unit (ICU) often associated with a poor outcome. In addition, clinically important changes in hemodynamic variables have been found to occur after diuretic therapy. This study was conducted to evaluate the safety and relative effectiveness of two diuretic protocols in the ICU. Twenty-two patients in the medical ICU with pulmonary edema or fluid overload and PaO2/FIO2 pressure less than 300, were randomized to diuretic therapy by either continuous infusion or intermittent bolus. Hemodynamic and biochemical measurements were recorded. Protocol-guided diuretic management can be readily and safely implemented in the ICU. Although both continuous and bolus diuretic regimens appear to be equally effective in achieving negative fluid balance, the clinician may consider a continuous infusion of furosemide in the hemodynamically and electrolytically unstable patient to ensure more controlled diuresis with less hemodynamic and electrolyte alteration. From a nursing perspective, a continuous infusion of furosemide is a more efficient means of drug delivery.
重症患者的正液体平衡是重症监护病房（ICU）常见的问题，常与不良预后相关。此外，利尿剂治疗后已发现血流动力学变量出现具有临床意义的变化。本研究旨在评估ICU中两种利尿剂方案的安全性和相对有效性。22名入住内科ICU、患有肺水肿或液体超负荷且PaO2/FIO2压力小于300的患者，被随机分为接受持续输注或间歇推注的利尿剂治疗。记录血流动力学和生化指标。方案指导的利尿剂管理可在ICU中轻松且安全地实施。尽管持续和推注利尿剂方案在实现负液体平衡方面似乎同样有效，但临床医生可能会考虑对血流动力学和电解质不稳定的患者持续输注呋塞米，以确保利尿更可控，血流动力学和电解质改变更少。从护理角度来看，持续输注呋塞米是一种更有效的给药方式。
