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目的观察小剂量呋塞米联合依那普利治疗慢性肺源性心脏病心力衰竭患者的临床疗效。方法 150名慢性肺源性心脏病心力衰竭患者随机分为试验组75例和对照组75例。对照组进行常规治疗;试验组在对照组治疗基础上,持续静脉泵入呋塞米2.5~5.0 mg·h~(-1),口服依那普利10~20 mg·d~(-1),共治疗2周。治疗前后2组患者均进行慢性阻塞性肺疾病和支气管哮喘生理评分(CAPS),比较2组患者的右心室舒张功能、住院时长、血流动力学、电解质情况以及不良反应发生情况。结果治疗后,试验组有创通气时间、住重症监护病房(ICU)时间、住院时间均明显短于对照组(均P<0.05)。试验组治疗后24,48,72 h的CAPS评分均显著优于对照组(均P<0.05)。2组治疗后全血黏度、血浆黏度较治疗前均明显降低,且试验组较对照组明显降低(均P<0.05)。治疗后,对照组血K~+、Na~+、Cl~-明显降低,试验组高于对照组(P<0.05)。2组治疗后E峰、Ve明显升高,A峰、Va明显降低,试验组变化更显著(P<0.05)。结论小剂量呋塞米持续静脉泵入联合依那普利对慢性肺源性心脏病心力衰竭患者有一定的临床疗效。
Objective To observe the clinical efficacy of low-dose furosemide combined with enalapril in the treatment of patients with chronic cor pulmonale heart failure. Methods 150 patients with chronic cor pulmonale heart failure were randomly divided into experimental group (75 cases) and control group (75 cases). The control group was given routine treatment. The experimental group was given intravenous furosemide 2.5 ~ 5.0 mg · h ~ (-1) and oral enalapril 10 ~ 20 mg · d ~ (-1) on the basis of the control group. For a total of 2 weeks. Before and after treatment, chronic obstructive pulmonary disease (COPD) and bronchial asthma physiological score (CAPS) were performed in both groups. The right ventricular diastolic function, hospitalization duration, hemodynamics, electrolytes and adverse reactions were compared between the two groups. Results After the treatment, the time of invasive ventilation, intensive care unit (ICU) and hospital stay in the experimental group were significantly shorter than those in the control group (all P <0.05). The CAPS scores of the experimental group at 24, 48 and 72 h after treatment were significantly better than those of the control group (all P <0.05). After treatment, the whole blood viscosity and plasma viscosity of the two groups were significantly lower than those before treatment, and the experimental group was significantly lower than the control group (all P <0.05). After treatment, the levels of K ~ +, Na ~ + and Cl ~ - in the control group were significantly lower than those in the control group (P <0.05). After treatment, E peak and Ve increased obviously, A peak and Va decreased obviously, and the changes of test group were more significant (P <0.05). Conclusion Continuous intravenous infusion of small doses of furosemide in combination with enalapril has certain clinical efficacy in patients with heart failure of chronic cor pulmonale.