循环利尿剂在心力衰竭管理中的作用在过去一个世纪的变化
Alberto Palazzuoli1, Pietro Mazzeo2,3, Martino Fortunato4
1Cardiovascular Diseases Unit Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, 53100 Siena, Italy.
Journal of clinical medicine
|March 28, 2024
概括
循环利尿剂对于急性心力衰竭 (HF) 拥堵至关重要,但缺乏标准化的方案. 本综述强调了一种统一的方法,以优化循环利尿药疗法,基于患者因素和心相互作用.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 拥堵是急性心力衰竭 (HF) 治疗的主要目标,循环利尿剂 (LDs) 是治疗的基石.
- 目前在急性HF中使用LD严重依赖临床经验和患者反应,缺乏标准化管理,持续时间和剂量升级指南.
- 尽管自1966年以来的历史悠久,但LD在最佳治疗策略方面仍未得到充分研究,特别是对于反应不佳或尿剂耐药的患者.
研究的目的:
- 审查循环利尿剂在急性心力衰竭管理中的历史使用和当前理解.
- 突出需要标准化,以证据为基础的循环利尿剂治疗方法.
- 为优化治疗,强调考虑临床条件,心相互作用和HF表型的重要性.
主要方法:
- 关于在急性心力衰竭中使用循环利尿剂的历史数据和当前文献的审查.
- 对监测利尿剂有效性的不断发展方法的分析,包括尿中的和肌素.
- 讨论顺序性脏阻塞策略及其长期影响.
主要成果:
- 循环利尿剂已经使用了几十年,但最佳的管理和剂量仍然在很大程度上是经验性的.
- 新兴的监测技术 (例如,尿,肌) 旨在预测利尿剂的效率并指导剂量.
- 顺序性脏阻塞显示出早期的希望,但需要进一步调查长期的神经内分泌和电解质效应.
结论:
- 在急性心力衰竭中需要一种通用,标准化的循环利尿疗法方法.
- 优化LD治疗需要整合临床状态,心状态和特定的HF表型.
- 进一步的研究是必要的,以解决关于先进的利尿剂策略的长期结果的不确定性.
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