Baptist Hospital, Saint Thomas Health Services, Nashville, TN, USA.
J Card Fail. 2010 Mar;16(3):188-93. doi: 10.1016/j.cardfail.2009.11.005. Epub 2010 Jan 6.
Despite advances in the treatment of chronic ambulatory heart failure, hospitalization rates for acute decompensated heart failure (ADHF) remain high. Although loop diuretics are used in nearly all patients with ADHF to relieve congestive symptoms, optimal dosing strategies remain poorly defined.
This was a prospective, randomized, parallel-group study comparing the effectiveness of continuous intravenous (cIV) with intermittent intravenous (iIV) infusion of furosemide in 56 patients with ADHF. The dose and duration of furosemide as well as concomitant medications to treat ADHF were determined by physician preference. The primary end point of the study was net urine output (nUOP)/24 hours. Safety measures including electrolyte loss and hemodynamic instability were also assessed. Twenty-six patients received cIV and 30 patients received iIV dosing. The mean nUOP/24 hours was 2098+/-1132 mL in patients receiving cIV versus 1575+/-1100 mL in the iIV group (P=.086). The cIV group had significantly greater total urine output (tUOP) with 3726+/-1121 mL/24 hours versus 2955+/-1267 mL/24 hours in the iIV group (P=.019) and tUOP/mg furosemide with 38.0+/-31.0 mL/mg versus 22.2+/-12.5 mL/mg (P=.021). Mean weight loss was not significantly different between the groups. The cIV group experienced a shorter length of hospital stay (6.9+/-3.7 versus 10.9+/-8.3 days, P=.006). There were no differences in safety measures between the groups.
The cIV of furosemide was well tolerated and significantly more effective than iIV for tUOP. In addition, continuous infusion appears to provide more efficient diuresis.
尽管慢性门诊心力衰竭的治疗取得了进展，但急性失代偿性心力衰竭（ADHF）的住院率仍然很高。尽管几乎所有 ADHF 患者都使用袢利尿剂来缓解充血症状，但最佳剂量策略仍未得到明确界定。
这是一项前瞻性、随机、平行组研究，比较了 56 例 ADHF 患者连续静脉（cIV）与间歇静脉（iIV）输注呋塞米的疗效。呋塞米的剂量和持续时间以及治疗 ADHF 的伴随药物由医生根据个人偏好确定。该研究的主要终点是 24 小时净尿量（nUOP）。还评估了安全性措施，包括电解质丢失和血液动力学不稳定。26 例患者接受 cIV 治疗，30 例患者接受 iIV 治疗。cIV 组患者 24 小时 nUOP 平均值为 2098+/-1132ml，iIV 组为 1575+/-1100ml（P=.086）。cIV 组总尿量（tUOP）明显更大，24 小时内为 3726+/-1121ml/24 小时，而 iIV 组为 2955+/-1267ml/24 小时（P=.019），24 小时内 tUOP/呋塞米用量为 38.0+/-31.0ml/mg，而 iIV 组为 22.2+/-12.5ml/mg（P=.021）。两组间平均体重减轻无显著差异。cIV 组的住院时间更短（6.9+/-3.7 天 vs. 10.9+/-8.3 天，P=.006）。两组间安全性措施无差异。
cIV 输注呋塞米耐受性良好，tUOP 明显优于 iIV。此外，连续输注似乎提供了更有效的利尿作用。
