【摘要】 目的探讨袢利尿剂托拉塞米不同静脉使用方式对急性失代偿心力衰竭住院病人肾功能的影响。方法采用回顾性队列研究,纳入2016年8月—2019年8月中日友好医院中西医结合心内科急性失代偿心力衰竭住院病人190例,收集在院期间临床数据,包括人口学资料、合并症、袢利尿剂使用方式及剂量、血清肌酐、尿素氮、尿酸、脑钠肽、血清钠、左室射血分数等。根据纳入人群利尿剂使用方式分为两组,即静脉持续输注组(48例)与静脉间歇给药组(132例)。采用单因素和多因素线性回归模型分析静脉袢利尿剂不同使用方式与血清肌酐水平变化的相关性。结果使用静脉袢利尿剂后,两组血清肌酐水平较治疗前均有一定程度升高(P=0.012),单因素分析结果显示,病人血清肌酐的升高与利尿剂使用方式有关(P<0.001);在校正利尿剂剂量、基线肌酐水平等混杂因素后,多因素线性回归分析结果显示,病人血清肌酐的升高与静脉袢利尿剂使用方式独立相关[β=66.80,95%CI(36.13,97.48),P<0.001],静脉持续输注是病人血清肌酐升高的独立危险因素。结论急性失代偿心力衰竭住院病人血清肌酐升高水平与袢利尿剂静脉不同使用方式有关,静脉持续输注给药相比于间歇给药可能会加重病人肾功能恶化。更多还原

【Abstract】 Objective To investigate the effect of different ways of loop diuretics on renal function in inpatients with acute decompensated heart failure.Methods A retrospective cohort study was conducted.One hundred and ninety inpatients with acute decompensated heart failure were collected,including demographic information,comorbidity,the usage and dosage of diuretics in the loop diuretic,serum creatinine,urea nitrogen,uric acid,brain natriuretic peptide,serum sodium,and left ventricular ejection fraction.According to the use of diuretic use,the included patients were divided into continuous infusion group(n=48) and intermittent ways group(n=132).Univariate and multivariate linear regression models were used to analyze the correlation between different intravenous diuretic administration and serum creatinine.Results After the use of loop diuretic,the levels of serum creatinine in both groups increased more than those before treatment(P=0.012).Univariate analysis showed that serum creatinine was associated with diuretic usage(P<0.001).After adjusting for confounding factors such as diuretic dose and baseline creatinine,multivariate linear regression analysis showed that the increase in serum creatinine was independently associated with the mode of intravenous diuretic use(β=66.80,95%CI(36.13,97.48),P<0.001),and continuous intravenous infusion was an independent risk factor for elevated serum creatinine in patients.Conclusion For inpatients with acute decompensated heart failure,continuous intravenous infusion might exacerbate renal function deterioration compared with intermittent administration of loop diuretic.更多还原