在急性减补性心力衰竭中尿液策略:叙述性审查
1, MD, FRCPC, is a Clinical Assistant Professor with the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
The Canadian journal of hospital pharmacy
|January 11, 2024
概括
在急性不补偿性心力衰竭中使用积极的循环利尿剂可以加快症状缓解并减少住院时间. 当初治疗不足时,辅助疗法,如 thiazides 和acetazolamide,有助于缓解血栓塞.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 心力衰竭是一种普遍的疾病,与显著的发病率,死亡率和医疗保健费用有关.
- 在住院期间不充分的脱血有助于高心力衰竭再入院率.
- 仅有有限的证据可以指导急性不补偿性心力衰竭的利尿剂策略.
研究的目的:
- 审查目前对急性不补偿性心力衰竭住院患者的利尿剂策略的建议.
- 检查当代利尿剂方法背后的证据和药理学理由.
- 为临床医生提供关于优化心力衰竭中流体管理的指导.
主要方法:
- 进行了文学叙事审查.
- 在PubMed,OVID和Embase数据库中从创建开始到2022年12月进行搜索.
- 纳入标准侧重于随机对照试验和系统性审查,包括至少100名成年患者,不包括特定的利尿剂.
主要成果:
- 早期,高剂量循环利尿剂的使用与更快的症状缓解,更短的住院时间和潜在的降低死亡率有关.
- 富罗塞米德是最常用的循环利尿剂,建议初始剂量是患者家用剂量的 2-2.5 倍.
- 补充性利尿剂如 thiazides 或acetazolamide 应考虑,如果堵塞持续24-48小时后最大化循环利尿疗法.
结论:
- 充血性心力衰竭的有效管理涉及高剂量循环利尿剂.
- 当不达到排挤目标时, thiazides 和acetazolamide 作为有价值的辅助剂.
- 目前正在进行的临床试验旨在进一步完善急性不补偿性心力衰竭的利尿剂策略.
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