Krämer B K, Schweda F, Riegger G A
Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Germany.
Am J Med. 1999 Jan;106(1):90-6. doi: 10.1016/s0002-9343(98)00365-9.
Diuretic therapy decreases capillary wedge pressure and improves New York Heart Association (NYHA) functional class both in acute and chronic heart failure. In advanced symptomatic heart failure, loop diuretics are generally necessary to improve symptoms of congestion. Diuretic resistance in the edematous patient has been defined as a clinical state in which diuretic response is diminished or lost before the therapeutic goal of relief from edema has been reached. The major causes of diuretic resistance are functional renal failure (prerenal azotemia), hyponatremia, altered diuretic pharmacokinetics, and sodium retention caused by counterregulatory mechanisms intended to reestablish the effective arterial blood volume. Therapeutic approaches to combat diuretic resistance include restriction of fluid and sodium intake, use of angiotensin-converting-enzyme (ACE) inhibitors, changes in route (oral, intravenous) and timing (single dose, multiple doses, continuous infusion) of diuretic therapy, and use of diuretic combinations.
利尿剂治疗可降低急性和慢性心力衰竭患者的毛细血管楔压，并改善纽约心脏协会（NYHA）的心功能分级。在晚期症状性心力衰竭中，通常需要使用袢利尿剂来改善充血症状。水肿患者的利尿剂抵抗被定义为一种临床状态，即在达到缓解水肿的治疗目标之前，利尿剂反应减弱或消失。利尿剂抵抗的主要原因是功能性肾衰竭（肾前性氮质血症）、低钠血症、利尿剂药代动力学改变以及旨在重建有效动脉血容量的反调节机制引起的钠潴留。对抗利尿剂抵抗的治疗方法包括限制液体和钠的摄入、使用血管紧张素转换酶（ACE）抑制剂、改变利尿剂治疗的途径（口服、静脉注射）和时间（单剂量、多剂量、持续输注）以及使用利尿剂联合用药。
