Ricci Zaccaria, Haiberger Roberta, Pezzella Chiara, Garisto Cristiana, Favia Isabella, Cogo Paola
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
Crit Care. 2015 Jan 7;19(1):2. doi: 10.1186/s13054-014-0724-5.
Clinical effects of furosemide (F) and ethacrynic acid (EA) continuous infusion on urine output (UO), fluid balance, and renal, cardiac, respiratory, and metabolic function were compared in infants undergoing surgery for congenital heart diseases.
A prospective randomized double-blinded study was conducted. Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.
In total, 38 patients were enrolled in the F group, and 36, in the EA group. No adverse reactions were recorded. UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P < 0.0001). Fluid balance was significantly more negative in the EA group at postoperative day 0: -43 (54) ml/kg/h versus -17 (32) ml/kg/h in the F group (P = 0.01). Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups. Metabolic alkalosis occurred frequently (about 70% of cases) in both groups, but mean bicarbonate level was higher in the EA group: 27.8 (1.5) M in the F group versus 29.1 (2) mM in the EA group (P = 0.006). Mean cardiac index (CI) values were 2.6 (0.1) L/min/m(2) in the F group compared with 2.98 (0.09) L/min/m(2) in the EA group (P = 0.0081). Length of mechanical ventilation was shorter in the EA group, 5.5 (8.8) days compared with the F group, 6.7 (5.9) (P = 0.06). Length of Pediatric Cardiac Intensive Care Unit (PCICU) admission was shorter in the EA group: 14 (19) days compared with 16 (15) in the F group (P = 0.046).
In cardiac surgery infants, EA produced more UO compared with F on POD0. Generally, a smaller EA dose is required to achieve similar UO than F. EA and F were safe in terms of renal function, but EA caused a more-intense metabolic alkalosis. EA patients achieved better CI, and shorter mechanical ventilation and PCICU admission time.
Clinicaltrials.gov NCT01628731. Registered 24 June 2012.
比较了速尿（F）和依他尼酸（EA）持续输注对先天性心脏病手术患儿尿量（UO）、液体平衡以及肾脏、心脏、呼吸和代谢功能的临床效果。
进行了一项前瞻性随机双盲研究。患者接受0.2mg/kg/h（最高0.8mg/kg/h）的F或EA。
F组共纳入38例患者，EA组纳入36例。未记录到不良反应。术后第0天（POD0）EA组的尿量显著高于F组，分别为6.9（3.3）ml/kg/h和4.6（2.3）ml/kg/h（P = 0.002），但此后两组尿量趋于相似。F的平均给药剂量为0.33（0.19）mg/kg/h，而EA为0.22（0.13）mg/kg/h（P < 0.0001）。术后第0天EA组的液体平衡显著更负：-43（54）ml/kg/h，而F组为-17（32）ml/kg/h（P = 0.01）。两组间血清肌酐、胱抑素C和中性粒细胞明胶酶相关脂质运载蛋白水平以及急性肾损伤发生率无显著差异。两组均频繁发生代谢性碱中毒（约70% 的病例），但EA组的平均碳酸氢盐水平更高：F组为27.8（1.5）mmol/L，EA组为29.1（2）mmol/L（P = 0.006）。F组的平均心脏指数（CI）值为2.6（0.1）L/min/m²，而EA组为2.98（0.09）L/min/m²（P = 0.0081）。EA组的机械通气时间更短，为5.5（8.8）天，而F组为6.7（5.9）天（P = 0.06）。EA组入住小儿心脏重症监护病房（PCICU）的时间更短：14（19）天，而F组为16（15）天（P = 0.046）。
在心脏手术患儿中，与F相比，EA在POD0时产生更多尿量。一般而言，与F相比，达到相似尿量所需的EA剂量更小。就肾功能而言，EA和F是安全的，但EA导致更严重的代谢性碱中毒。使用EA的患者心脏指数更好，机械通气和入住PCICU的时间更短。
Clinicaltrials.gov NCT01628731。于2012年6月24日注册。
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