APHP, Cardiovascular Department and INSERM U955, Team 3, Henri Mondor University Hospital.
Circ J. 2013;77(10):2612-8. doi: 10.1253/circj.cj-13-0404. Epub 2013 Jul 13.
The benefit of load expansion is controversial in acute pulmonary embolism (PE). The aim of this study was to evaluate the benefit of furosemide in cases of normotensive acute PE.
We retrospectively included 70 consecutive normotensive patients (systolic blood pressure ≥ 90 mmHg) admitted for acute PE with right ventricular dilation. Overall, 40 patients were treated during the first 24h by repeated bolus of furosemide (78 ± 42 mg, range 40-160 mg) and 30 patients received isotonic saline solution (1.6 ± 0.9L). Severity of hemodynamic status was similar in both groups, but patients in the furosemide group were older and had a greater creatinine level. At 24h, only the furosemide group had a decreased shock index (0.82 ± 0.22 vs. 0.63 ± 0.16, P<0.0001) with improved systolic blood pressure (118 ± 18 vs. 133 ± 17 mmHg, P<0.0001), and creatinine levels. After treatment, there were fewer patients with simplified pulmonary embolism severity index ≥ 1 in the diuretic group (45% vs. 55%, P=0.03) than in the fluid expansion group (47% vs. 40%, P<0.0001). Finally, oxygen requirement at 24h decreased only in the diuretic group (75% to 47%, P=0.0004), and in-hospital survival without death and PE-related shock were similar between the 2 groups.
In normotensive PE with RV dilatation, diuretics may improve hemodynamics and oxygenation requirement.
在急性肺栓塞（PE）中，负荷扩张的益处存在争议。本研究旨在评估速尿在血压正常的急性 PE 中的益处。
我们回顾性纳入了 70 例连续的血压正常（收缩压≥90mmHg）的急性 PE 合并右心室扩张患者。总体而言，40 例患者在最初 24 小时内接受了速尿重复推注治疗（78±42mg，范围 40-160mg），30 例患者接受了等渗生理盐水溶液（1.6±0.9L）。两组患者的血流动力学状态严重程度相似，但速尿组患者年龄更大，肌酐水平更高。在 24 小时时，仅速尿组的休克指数降低（0.82±0.22 比 0.63±0.16，P<0.0001），收缩压升高（118±18 比 133±17mmHg，P<0.0001），肌酐水平降低。治疗后，利尿剂组简化肺栓塞严重指数≥1 的患者比例（45%比 55%，P=0.03）低于液体扩张组（47%比 40%，P<0.0001）。最后，只有利尿剂组的 24 小时氧需求降低（75%降至 47%，P=0.0004），并且两组的住院期间死亡率和 PE 相关性休克均无差异。
在 RV 扩张的血压正常的 PE 中，利尿剂可能改善血流动力学和氧需求。
