目的 研究大劑量呋塞米持續(xù)靜脈泵入對早期急性腎損傷伴急性肺水腫的臨床療效。方法 選擇2012年2月~2015年12月在陜西省人民醫(yī)院進(jìn)行診治的早期急性腎損傷伴急性肺水腫患者180例，所有患者均先持續(xù)靜脈泵入1~2 mg/min呋塞米，再按照患者尿量的多少調(diào)整呋塞米的用藥劑量。分別在治療前和治療后6、12、24、48、72 h，觀察并記錄患者的血肌酐、血尿素氮、氧合指數(shù)、血鉀、機(jī)械通氣時(shí)間、pH值、預(yù)后情況和不良反應(yīng)發(fā)生情況。結(jié)果 呋塞米用藥劑量開始減少的時(shí)間平均為（12.15±3.12）h；呋塞米的應(yīng)用時(shí)間平均為（46.31±4.89）h；治療后各時(shí)間點(diǎn)患者的血肌酐、血尿素氮、氧合指數(shù)、pH值和血鉀均與治療前有明顯差異（P<0.05），且治療后各時(shí)間點(diǎn)上述觀察指標(biāo)均有明顯差異（P<0.05）；180例患者中，治療后有161例腎功能恢復(fù)，占89.44%，呼吸困難的癥狀得到明顯減輕，X線胸片發(fā)現(xiàn)肺水腫有明顯好轉(zhuǎn)，成功停止機(jī)械通氣，機(jī)械通氣時(shí)間平均為（35.28±11.37）h；在治療過程中，180例患者血流動(dòng)力學(xué)穩(wěn)定，均未出現(xiàn)低血壓、耳聾和耳鳴等不良反應(yīng)。結(jié)論 給予大劑量呋塞米治療早期急性腎損傷伴急性肺水腫，能明顯增加尿量，改善腎功能、內(nèi)環(huán)境紊亂和預(yù)后，提高救治成功率。

Objective To investigate the clinical effect of high-dose cefuroxime continuous iv pumping on early acute renal injury accompanied by acute lung edema. Methods Selected 180 cases of patients with early acute renal injury accompanied by acute lung edema who were treated in Shanxi Provincial People's Hospital from January 2012 to December 2015. All patients were treated with 1-2 mg/min furosemide continuous infusion, the amount of furosemide was adjusted according to a target urine output. The serum creatinine, blood urea nitrogen, oxygenation index, potassium, mechanical ventilation time, pH, prognosis and adverse reactions before and after treatment 6, 12, 24, 48, and 72 h were observed and recorded. Results Cefuroxime dosage began to decrease at the average time point of (12.15±3.12) h; The average application time was (46.31±4.89) h; Compared with before treatment, serum creatinine, blood urea nitrogen, oxygen and index, pH and potassium at each time point after treatment have obvious difference (P<0.05), and each time point after treatment had significant difference (P<0.05); After treatment, 161 cases had renal function recovery, accounted for 89.44%, the symptoms of dyspnea, X-ray chest radiograph had improved markedly, successful stop mechanical ventilation; The average mechanical ventilation time was (35.28±11.37) h; In the process of treatment, 180 cases of patients with stable hemodynamics, all did not appear adverse reactions such as deafness and tinnitus. Conclusion Using high-dose cefuroxime to treat early acute renal injury accompanied by acute lung edema can obviously increase urine output, improve renal function, disorder of internal environment and prognosis, and improve the successful rate.