Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
International Medical University, Kuala Lumpur, Malaysia.
Anaesthesia. 2018 Feb;73(2):238-247. doi: 10.1111/anae.14038. Epub 2017 Sep 22.
Loop diuretics remain a fundamental pharmacological therapy to remove excess fluid and improve symptom control in acute decompensated heart failure. Several recent randomised controlled trials have examined the clinical benefit of continuous vs. bolus furosemide in acute decompensated heart failure, but have reported conflicting findings. The aim of this review was to compare the effects of continuous and bolus furosemide with regard to mortality, length of hospital stay and its efficacy profile in acute decompensated heart failure. All parallel-arm randomised controlled trials from MEDLINE, EMBASE, PubMed and the Cochrane Database of Systematic Reviews from inception until May 2017 were included. Cross-over randomised controlled trials, observational studies, case reports, case series and non-systematic reviews that involved children were excluded. Eight trials (n = 669) were eligible for inclusion. There was no difference between furosemide continuous infusion and bolus administration for all-cause mortality (four studies; n = 491; I = 0%; OR 1.65; 95%CI 0.93-2.91; p = 0.08) or duration of hospitalisation (six studies; n = 576; I = 71%; mean difference 0.27; 95%CI -1.35 to 1.89 days; p = 0.74). Continuous infusion of intravenous furosemide was associated with increased weight reduction (five studies; n = 516; I = 0%; mean difference 0.70; 95%CI 0.12-1.28 kg; p = 0.02); increased total urine output in 24 h (four studies; n = 390; I = 33%; mean difference 461.5; 95%CI 133.7-789.4 ml; p < 0.01); and reduced brain natriuretic peptide (two studies; n = 390; I = 0%; mean difference 399.5; 95%CI 152.7-646.3 ng.l ; p < 0.01), compared with the bolus group. There was no difference in the incidence of raised creatinine and hypokalaemia between the two groups. In summary, there was no difference between continuous infusion and bolus of furosemide for all-cause mortality, length of hospital stay and electrolyte disturbance, but continuous infusion was superior to bolus administration with regard to diuretic effect and reduction in brain natriuretic peptide.
袢利尿剂仍然是一种基本的药理学治疗方法，可用于去除急性失代偿性心力衰竭患者体内多余的液体并改善症状控制。几项最近的随机对照试验研究了连续输注与推注呋塞米在急性失代偿性心力衰竭中的临床益处，但报告的结果相互矛盾。本综述的目的是比较连续输注和推注呋塞米在急性失代偿性心力衰竭中的死亡率、住院时间及其疗效特征。我们纳入了从 MEDLINE、EMBASE、PubMed 和 Cochrane 系统评价数据库中检索到的所有平行臂随机对照试验，检索时间截至 2017 年 5 月。排除交叉随机对照试验、观察性研究、病例报告、病例系列和非系统性综述，这些研究均涉及儿童。八项试验（n = 669）符合纳入标准。连续输注呋塞米与推注呋塞米在全因死亡率方面没有差异（四项研究；n = 491；I = 0%；OR 1.65；95%CI 0.93-2.91；p = 0.08）或住院时间（六项研究；n = 576；I = 71%；平均差异 0.27；95%CI -1.35 至 1.89 天；p = 0.74）。静脉注射呋塞米连续输注与体重减轻增加相关（五项研究；n = 516；I = 0%；平均差异 0.70；95%CI 0.12-1.28kg；p = 0.02）；24 小时内总尿量增加（四项研究；n = 390；I = 33%；平均差异 461.5；95%CI 133.7-789.4ml；p < 0.01）；脑利钠肽减少（两项研究；n = 390；I = 0%；平均差异 399.5；95%CI 152.7-646.3ng.l ；p < 0.01），与推注组相比。两组间血肌酐升高和低钾血症的发生率无差异。总之，连续输注和推注呋塞米在全因死亡率、住院时间和电解质紊乱方面没有差异，但连续输注在利尿效果和脑利钠肽降低方面优于推注。
