Timio M, Saronio P, Venanzi S, Bellomo G, Timio F
Dipartimento Medicina Interna, Nefrologia e Dialisi, Ospedale San Giovanni Battista, Foligno (PG).
G Ital Nefrol. 2006 Jan-Feb;23 Suppl 34:S44-6.
Diuretics are an integral part of the management of symptomatic heart failure. Although they have been used for several decades, there is still some ambiguity and confusion regarding the outcome and the optimal way of using these common agents. There are no large-scale randomized controlled trials that have evaluated the effect of diuretics on mortality and long-term morbidity in diastolic and systolic dysfunction. Nonetheless, in short-term studies furosemide has demonstrated to reduce symptomatic congestive heart failure and hospitalization, and to improve exercise capacity in the setting of systolic dysfunction. In this review, the classes, sites of action and renal effect of diuretics are reviewed and the various indications, optimal doses and recommendations on effective use and disuse are discussed. Namely, this review addresses the effects of emerging diuretic agents such as eplerenone--a selective mineral corticoid receptor antagonist, nesiritide--a brain natriuretic peptide-recombinant, and conivaptan--a vasopressin antagonist, in attempt to provide an update on current knowledge, even though adequate clinic data are not available for all agents.
利尿剂是有症状心力衰竭治疗中不可或缺的一部分。尽管它们已被使用了几十年，但在这些常用药物的疗效及最佳使用方法方面仍存在一些模糊和混淆之处。目前尚无大规模随机对照试验评估利尿剂对舒张功能障碍和收缩功能障碍患者死亡率及长期发病率的影响。尽管如此，在短期研究中，呋塞米已证明可减轻有症状的充血性心力衰竭并减少住院次数，并可改善收缩功能障碍患者的运动能力。在本综述中，将对利尿剂的类别、作用部位及肾脏效应进行综述，并讨论其各种适应证、最佳剂量以及有效使用和停用的建议。具体而言，本综述探讨了新型利尿剂如依普利酮（一种选择性盐皮质激素受体拮抗剂）、奈西立肽（一种重组脑钠肽）和考尼伐坦（一种血管加压素拮抗剂）的作用，旨在更新当前的知识，尽管并非所有药物都有足够的临床数据。
