中文摘要：

目的：探讨大剂量呋塞米强化利尿治疗效果及持续静脉输注与单次及分次静脉注射给药在难治性心力衰竭治疗中的疗效差异。方法：收集难治性心力衰竭患者21例，给予600mg·d^-1。呋塞米强化利尿治疗，观察其利尿效果和电解质、肾功能、神经内分泌因子变化，并采用随机交叉对照设计，对比持续静脉输注与单次及分次静脉注射的临床疗效差异和药动学差异。结果：强化利尿患者由治疗前平均尿量（1154±254）mL·d^-1，增加至（2517±366）mL·d^-1，差异极显著，同时伴有血肌酐和肾素水平升高和血钾水平下降。持续静脉输注、分次及单次静脉注射的平均尿量分别为（2808±415）mL·d^-1,（2473±388）mL·d^-1和（2269±434）mL·d^-1，差异极显著。持续静脉输注组高水平血药浓度持续时间更长。结论：大剂量呋塞米强化利尿可显著增加利尿效果，改善心脏功能，其中持续静脉输注组疗效显著优于分次静脉注射组和单次静脉注射组。其疗效优越可能与持续静脉输注组高水平血药浓度持续时间更长有关。

英文摘要：

OBJECTIVE： To explore the efficacy of aggressive diuresis with high dose furosemide in refractory heart failure and the difference among continuous infusion, single and double bolus injection of furosemide. METHODS Twenty-one patients with refractory heart failure were recruited in the study, the urinary volume, blood ions, creatinine, and neuro-hormone factors were assayed before and after treatment. The difference of diuresis and pharmacokinetic measurements among continuous infusion, single and double bolus injection of furosemide were compared too. RESULTS The urinary volume was （2 517 ± 366）mL.d^-1 after aggressive diuresis, more than treatment before which was （ 1 154 ± 254）mL.d ^-1. The serum plasma creati nine, plasma rennin increased and serum potassium decreased. The urinary volume in continuous infusion, double and single bolus injection of furosemide were （2 808 ± 415） mL.d^-1 , （2 473 ± 388）mL.d^-1 , and （2 269± 434）mL.d^-1 respectively, which had significantly difference. The high level concentration of furosemide sustained longer in continuous infusion group. CONCLUSION Aggressive treatment with furosemide can increase the efficacy of diuresis and improve the heart function. The efficacy of diuresis in continuous infusion group is stronger than that in bolus groups, which perhaps is related with the sustained high level furosemide concentration.