摘要
虽然髓袢利尿剂是最常用的治疗急性心力衰竭(AHF)的药物,但其短期和长期影响并不十分明确。在治疗HF时特别是急性失代偿发作期间,髓袢利尿剂是必不可少的,因此超过90%的HF患者使用本药进行治疗。静脉循环利尿剂治疗心力衰竭患者通常会导致呼吸困难、肺充血和左心室充盈压的降低。然而,人们对其治疗AHF的适当剂量、时机和给药方式了解甚少:一些副作用可能由于高剂量给药、肾功能恶化、利尿剂抵抗和交感神经超速所导致。此外,没有具体证据表明连续性给药方式治疗AHF时疗效优于与间歇性给药方式。当前基于小型异构研究的数据并没有明确表明,为了在将来提供明确的建议而需要完成一个明确的风险收益率和更大的前瞻性试验。因为每一个病人是一个单一的实体,并对相同的治疗方式有着不同的反应,临床最佳方法应考虑到体检、神经内分泌超速及肾功能状态。由于这些原因,使用髓袢利尿剂治疗时应为每个病人量身定制,直到多中心盲试验明确提供最佳剂量、给药方式和精确的目标等数据。
关键词: 急性心力衰竭,住院,髓袢利尿剂,疗效,治疗,肾功能恶化。
Current Drug Targets
Title:Loop Diuretics Strategies in Acute Heart Failure: From Clinical Trials to Practical Application
Volume: 16 Issue: 11
Author(s): Alberto Palazzuoli, Gaetano Ruocco, Marco Pellegrini, Matteo Beltrami, Gabriele Del Castillo and Ranuccio Nuti
Affiliation:
关键词: 急性心力衰竭,住院,髓袢利尿剂,疗效,治疗,肾功能恶化。
摘要: Although loop diuretics are the most commonly used drugs for the treatment of acute heart failure (AHF), their short and long-term effects are relatively unknown. The use of loop diuretics is essential in the management of HF, particularly during episodes of acute decompensation, therefore more than 90% of patients admitted with HF receive this drug. The administration of intravenous loop diuretics to patients with heart failure and congestion typically results in the improvement of dyspnea, pulmonary congestion and in the reduction of Left Ventricular (LV) filling pressures. However, little is known about its appropriate dose, timing and modality administration in patients with AHF: several side effects may result from the administration of high diuretics dose, including worsening kidney function, diuretic resistance and sympathetic overdrive. Furthermore, there is no specific strategy that shows a clear benefit in HF outcome in relation to continuous versus intermittent administration modalities. Current data based on small and heterogeneous studies did not demonstrate a clear risk benefit ratio and larger prospective trials need to be completed in order to be able to provide definitive recommendations in the future. Since every patient represents a single entity and may have different responses to the same treatment, the best clinical approach should take into account physical examination, neuro-hormonal overdrive and kidney functional status. Due to these reasons, treatment with loop diuretics should be specifically customized for each patient, until multicenter blinded trials will provide satisfactory answers regarding optimal dosing, modality administration and precise targets.
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Cite this article as:
Alberto Palazzuoli, Gaetano Ruocco, Marco Pellegrini, Matteo Beltrami, Gabriele Del Castillo and Ranuccio Nuti , Loop Diuretics Strategies in Acute Heart Failure: From Clinical Trials to Practical Application, Current Drug Targets 2015; 16 (11) . https://dx.doi.org/10.2174/1389450116666150420125531
DOI https://dx.doi.org/10.2174/1389450116666150420125531 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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