Biomedical Department of Internal and Specialty Medicine, University of Palermo, Piazza delle Cliniche 2, Palermo, Italy.
J Card Fail. 2011 Apr;17(4):331-9. doi: 10.1016/j.cardfail.2010.11.003. Epub 2010 Dec 24.
The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure.
Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/24 h), and low natriuresis (<60 mEq/24 h) were randomized into 2 groups (double blind). The first group received a furosemide infusion (250 mg) plus HSS (150 mL 3.0% Na) bid and light Na restriction (120 mmol), and the second group received furosemide infusion (250 mg) twice daily, and low Na diet (80 mmol). The fluid intake of both groups was restricted (1 L/d). Body weight, whole-body bioelectrical impedance analysis (BIA), 24-hour urinary volume, and serum and urinary laboratory parameters were measured daily. Estimations of echocardiographic PCWP (Echo-PCWP) were detected on entry, 1 hour after concluding the initial treatment, and 6 days thereafter. A total of 133 patients (47 women and 86 men), aged 65-82 years, met the entry criteria.The HSS group revealed a significant increase in daily diuresis, natriuresis, and serum sodium compared with the furosemide group. Six days after treatment, renal function was significantly improved in the HSS group. Both groups showed a significant reduction in Echo-PCWP, but the HHS group revealed a faster reduction and significant lower values at 6 days compared with the group taking furosemide alone. We observed a positive correlation between values of Echo-PCWP and BNP and an inverse correlation between BIA parameters and Echo-PCWP.
Our data show that the combination of high diuretic dose and HSS infusion plus light restriction in dietary sodium intake determine a more rapid and significant hemodynamic stabilization through the improvement of echo-PCWP, BNP levels, and BIA parameters than the group treated without HSS.
本研究旨在验证与单独使用高剂量呋塞米相比，高渗盐水溶液（HSS）加高剂量呋塞米和限制钠摄入量对充血性心力衰竭失代偿患者肺毛细血管楔压（PCWP）的影响，方法为通过多普勒超声心动图和组织多普勒成像进行检测。
连续纳入纽约心脏协会心功能 IV 级患者，他们对口服大剂量呋塞米（250-500mg/d）和/或联合应用利尿剂反应不佳，射血分数<40%，血清肌酐<2mg/dL，血尿素氮≤60mg/dL，尿量减少（<500mL/24h），且尿钠排泄量低（<60mEq/24h）。这些患者被随机分为两组（双盲）。第一组接受呋塞米输注（250mg）加 HSS（150mL 3.0% Na）bid 和轻度钠限制（120mmol），第二组接受呋塞米输注（250mg）bid 和低钠饮食（80mmol）。两组均限制液体摄入（1L/d）。每日测量体重、全身生物电阻抗分析（BIA）、24 小时尿量以及血清和尿液实验室参数。在入组时、初始治疗结束后 1 小时以及 6 天后检测超声心动图 PCWP（Echo-PCWP）的估计值。共有 133 名患者（47 名女性和 86 名男性）符合入组标准，年龄 65-82 岁。与呋塞米组相比，HSS 组的每日尿量、尿钠排泄量和血清钠均显著增加。治疗 6 天后，HSS 组肾功能显著改善。两组均显著降低了 Echo-PCWP，但 HHS 组在 6 天时的降低速度更快，值也更低。我们观察到 Echo-PCWP 与 BNP 值之间存在正相关，与 BIA 参数与 Echo-PCWP 之间存在负相关。
我们的数据表明，与单独使用呋塞米相比，高剂量利尿剂联合 HSS 输注和限制饮食钠摄入可通过改善 Echo-PCWP、BNP 水平和 BIA 参数更快、更显著地稳定血液动力学。
