Singh N C, Kissoon N, al Mofada S, Bennett M, Bohn D J
Children's Hospital, Western Ontario, London, Canada.
Crit Care Med. 1992 Jan;20(1):17-21. doi: 10.1097/00003246-199201000-00010.
To compare the effects of furosemide administered by intermittent iv infusion vs. continuous iv infusion on urine output, hemodynamic variables, and serum electrolyte concentrations.
Prospective, randomized trial.
Pediatric ICU.
Postoperative pediatric cardiac patients.
Patients were assigned to either the continuous iv infusion or the intermittent infusion groups. The intermittent group received 1 mg/kg iv of furosemide every 4 hrs to be increased by 0.25 mg/kg iv every 4 hrs to a maximum of 1.5 mg/kg iv if the urine output was less than 1 mL/kg.hr. The continuous infusion group received an initial furosemide dose of 0.1 mg/kg iv (minimum 1 mg) followed by an iv infusion rate of 0.1 mg/kg.hr of furosemide to be doubled every 2 hrs to a maximum of 0.4 mg/kg.hr if the urine output was less than 1 mL/kg.hr.
Demographic variables, fluids, electrolyte and inotropic requirements were the same in both groups. A significantly (p = .045) lower daily dose of furosemide (4.90 +/- 1.78 vs. 6.23 +/- 0.62 mg/kg.day) in the continuous iv infusion group produced the same 24-hr urine volume as that of the intermittent group. There was more variability in urine output in the intermittent group as well as more urinary losses of sodium (0.29 +/- 0.15 vs. 0.20 +/- 0.06 mmol/kg.day, p = .0007) and chloride (0.40 +/- 0.20 vs. 0.30 +/- 0.12 mmol/kg.day, p = .045).
Furosemide administered by continuous iv infusion is advantageous in the post-operative pediatric patient because of a more controlled and predictable urine output with less drug requirement and less urinary loss in sodium and chloride.
比较间歇性静脉输注与持续性静脉输注呋塞米对尿量、血流动力学变量及血清电解质浓度的影响。
前瞻性随机试验。
儿科重症监护病房。
儿科心脏术后患者。
患者被分配至持续性静脉输注组或间歇性输注组。间歇性组每4小时静脉注射1 mg/kg呋塞米，若尿量小于1 mL/kg·小时，则每4小时增加0.25 mg/kg静脉注射量，最大至1.5 mg/kg静脉注射量。持续性输注组初始静脉注射呋塞米剂量为0.1 mg/kg（最小1 mg），随后以0.1 mg/kg·小时的静脉输注速率给药，若尿量小于1 mL/kg·小时，则每2小时加倍，最大至0.4 mg/kg·小时。
两组的人口统计学变量、液体、电解质及强心药需求相同。持续性静脉输注组呋塞米的每日剂量显著更低（4.90±1.78 vs. 6.23±0.62 mg/kg·天），但24小时尿量与间歇性组相同。间歇性组尿量变异性更大，钠（0.29±0.15 vs. 0.20±0.06 mmol/kg·天，p = 0.0007）和氯（0.40±0.20 vs. 0.30±0.12 mmol/kg·天，p = 0.045）的尿丢失也更多。
对于儿科术后患者，持续性静脉输注呋塞米具有优势，因为尿量控制更好、更可预测，药物需求更少，钠和氯的尿丢失也更少。
