目的探讨不同方法使用呋塞米对合并肾功能不全的急性心力衰竭患者心功能、肾脏功能及预后的影响。方法采用前瞻性观察研究,选择本院合并肾功能不全的急性心力衰竭患者随机分组,除常规治疗外,对照组给予间断静脉注射呋塞米,研究组给予静...目的探讨不同方法使用呋塞米对合并肾功能不全的急性心力衰竭患者心功能、肾脏功能及预后的影响。方法采用前瞻性观察研究,选择本院合并肾功能不全的急性心力衰竭患者随机分组,除常规治疗外,对照组给予间断静脉注射呋塞米,研究组给予静脉持续微量泵入呋塞米。分别观察两组患者第3d和第5d尿量、血肌酐水平、尿素氮水平、肾小球滤过率(e GFR)、B型利钠肽、平均动脉压、心率、血钾水平;记录两组患者ICU住院时间、总住院时间和统计28d病死率。结果共有66例急性心力衰竭患者入选,与对照组相比,研究组患者入组后第3d(2358±584 vs 2096±439ml/d,P<0.05),第5d(2447±653vs 2153±482ml/d,P<0.05)平均尿量更多;B型利钠肽水平第3d(624.5±364 vs 845±513pg/ml,P<0.05),第5d(587±328.5 vs 796.5±484pg/ml,P<0.05)下降更为更明显.但研究组患者血肌酐水平第3d(158±38.7 vs 137±25.8umol/l,P<0.05),第5d(143±32.3 vs122±23umol/l,P<0.05)、尿素氮水平第3d(16.58±11.05 vs 11.34±8.34mmol/l,P<0.05),第5d(15.89±10.63 vs 10.91±7.86mmol/l,P<0.05)明显高于对照组,肾小球滤过率第3d(58.51±7.02 vs 63.07±7.34ml/min/1.73m2,P<0.05)第5d(61.06±7.27 vs 65.34±7.55ml/min/1.73m2,P<0.05)低于对照组,而在不同时间点两组的平均动脉压、心率及血钾水平无统计学差异。两组患者ICU住院时间(天:9.56±3.35 vs 8.54±3.03,0.2001)、总住院时间(天:18.7±8.9 vs 21.5±9.7,P=0.2258)及28d病死率(%:23.68 vs 26.83P>0.05)均无统计学差异。结论对合并肾功能不全的急性心力衰竭患者,同间断静脉注射相比,持续微量泵注射泵入呋塞米能有效增加尿量及降低B型利钠肽水平,改善患者心脏功能,但会增加患者血肌酐及尿素氮水平,降低肾小球滤过率,加重肾损伤。在降低ICU及总住院天数、降低病死率和方面,两组没有显著差异。展开更多
Background： The antibiotic meropenem is commonly administered pharmacokinetic, clinical, and bacteriological efficacies of continuous patients. n patients with severe sepsis and septic shock. We compared the infusion...Background： The antibiotic meropenem is commonly administered pharmacokinetic, clinical, and bacteriological efficacies of continuous patients. n patients with severe sepsis and septic shock. We compared the infusion of meropenem versus internaittent administration in such Methods： Patients admitted to the Intensive Care Unit （ICU） with severe sepsis or septic shock who received meropenem were randomly assigned to either the continuous （n = 25） or intermittent groups 01 = 25）. The continuous group received a loading dose of 0.5 g of meropenem lbllowed by a continuous infusion of 3 g/day： the intermittent group received an initial dose of 1.5 g lbllowed by 1 g lbr every 8 h. Clinical success, microbiological eradication, superinfection, ICU mortality, length of ICU stay, and duration of meropenem treatment were assessed. Serial plasma meropenem concentrations tbr the first and third dosing periods （steady state） were also measured. Results： Clinical success was similar in both the continuous （64%） and intermittent （56%） groups （P = 0.564）： the rates of microbiological eradication and superinfection （81.8% vs. 66.7% [P = 0.255] and 4% vs. 16% [P 0.157], respectively） showed improvement in the continuous group. The duration of meropenem treatment was significantly shorter in the continuous group （7.6 vs. 9.4 days; P = 0.035）, where a better steady-state concentration was also achieved. Peak and trough concentrations were significantly different between the continuous and intermittent groups both in the first （Cmax： 19.8 mg/L vs. 51.8 mg/L, P = 0.000; Cmin： 11.2 mg/L vs. 0.5 nag/L, P = 0.000） and third dosing periods （Cmax： 12.5 mg/L vs. 46.4 rag/L, P = 0.000; Cmin： 11.4 mg/L vs. 0.6 rag/L, P = 0.000）. For medium-susceptibility pathogens, continuous inthsion concentrations above the minimal inhibitory concentration were 100%, which was better than that in the intermittent group- Conclusions： Continuous infusion of meropenem provides significantly shorter t展开更多
文摘目的评价万古霉素持续输注与间断输注两种不同给药方式治疗成人患者革兰阳性杆菌的优劣。方法检索Pub Med、EMBase、Cochrane Library、中国知网、万方数据库、中国生物医学文摘数据库,纳入万古霉素持续输注与间断输注两种不同给药方式的研究,对纳入的研究进行描述性分析,同时用Rev Man 5.0软件进行Meta分析。结果共纳入观察性研究7篇和随机对照研究1篇,共纳入患者869例,其中用持续输注的患者535例,用间断输注的患者334例。持续输注组在临床失败率、死亡率与间断输注组相比差异无统计学意义(P>0.05),但持续输注组的肾毒性发生率明显低于间断输注组(P<0.05)。结论万古霉素持续输注在降低肾毒性发生率方面要优于间断输注,在临床失败率和死亡率方面两者没有显著性差异。
文摘目的探讨不同方法使用呋塞米对合并肾功能不全的急性心力衰竭患者心功能、肾脏功能及预后的影响。方法采用前瞻性观察研究,选择本院合并肾功能不全的急性心力衰竭患者随机分组,除常规治疗外,对照组给予间断静脉注射呋塞米,研究组给予静脉持续微量泵入呋塞米。分别观察两组患者第3d和第5d尿量、血肌酐水平、尿素氮水平、肾小球滤过率(e GFR)、B型利钠肽、平均动脉压、心率、血钾水平;记录两组患者ICU住院时间、总住院时间和统计28d病死率。结果共有66例急性心力衰竭患者入选,与对照组相比,研究组患者入组后第3d(2358±584 vs 2096±439ml/d,P<0.05),第5d(2447±653vs 2153±482ml/d,P<0.05)平均尿量更多;B型利钠肽水平第3d(624.5±364 vs 845±513pg/ml,P<0.05),第5d(587±328.5 vs 796.5±484pg/ml,P<0.05)下降更为更明显.但研究组患者血肌酐水平第3d(158±38.7 vs 137±25.8umol/l,P<0.05),第5d(143±32.3 vs122±23umol/l,P<0.05)、尿素氮水平第3d(16.58±11.05 vs 11.34±8.34mmol/l,P<0.05),第5d(15.89±10.63 vs 10.91±7.86mmol/l,P<0.05)明显高于对照组,肾小球滤过率第3d(58.51±7.02 vs 63.07±7.34ml/min/1.73m2,P<0.05)第5d(61.06±7.27 vs 65.34±7.55ml/min/1.73m2,P<0.05)低于对照组,而在不同时间点两组的平均动脉压、心率及血钾水平无统计学差异。两组患者ICU住院时间(天:9.56±3.35 vs 8.54±3.03,0.2001)、总住院时间(天:18.7±8.9 vs 21.5±9.7,P=0.2258)及28d病死率(%:23.68 vs 26.83P>0.05)均无统计学差异。结论对合并肾功能不全的急性心力衰竭患者,同间断静脉注射相比,持续微量泵注射泵入呋塞米能有效增加尿量及降低B型利钠肽水平,改善患者心脏功能,但会增加患者血肌酐及尿素氮水平,降低肾小球滤过率,加重肾损伤。在降低ICU及总住院天数、降低病死率和方面,两组没有显著差异。
文摘Background： The antibiotic meropenem is commonly administered pharmacokinetic, clinical, and bacteriological efficacies of continuous patients. n patients with severe sepsis and septic shock. We compared the infusion of meropenem versus internaittent administration in such Methods： Patients admitted to the Intensive Care Unit （ICU） with severe sepsis or septic shock who received meropenem were randomly assigned to either the continuous （n = 25） or intermittent groups 01 = 25）. The continuous group received a loading dose of 0.5 g of meropenem lbllowed by a continuous infusion of 3 g/day： the intermittent group received an initial dose of 1.5 g lbllowed by 1 g lbr every 8 h. Clinical success, microbiological eradication, superinfection, ICU mortality, length of ICU stay, and duration of meropenem treatment were assessed. Serial plasma meropenem concentrations tbr the first and third dosing periods （steady state） were also measured. Results： Clinical success was similar in both the continuous （64%） and intermittent （56%） groups （P = 0.564）： the rates of microbiological eradication and superinfection （81.8% vs. 66.7% [P = 0.255] and 4% vs. 16% [P 0.157], respectively） showed improvement in the continuous group. The duration of meropenem treatment was significantly shorter in the continuous group （7.6 vs. 9.4 days; P = 0.035）, where a better steady-state concentration was also achieved. Peak and trough concentrations were significantly different between the continuous and intermittent groups both in the first （Cmax： 19.8 mg/L vs. 51.8 mg/L, P = 0.000; Cmin： 11.2 mg/L vs. 0.5 nag/L, P = 0.000） and third dosing periods （Cmax： 12.5 mg/L vs. 46.4 rag/L, P = 0.000; Cmin： 11.4 mg/L vs. 0.6 rag/L, P = 0.000）. For medium-susceptibility pathogens, continuous inthsion concentrations above the minimal inhibitory concentration were 100%, which was better than that in the intermittent group- Conclusions： Continuous infusion of meropenem provides significantly shorter t
