活动伴步行可减弱慢性心力衰竭患者的利尿剂反应性。

Activity with ambulation attenuates diuretic responsiveness in chronic heart failure.

机构信息

University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Card Fail. 2011 Oct;17(10):797-803. doi: 10.1016/j.cardfail.2011.06.652.

DOI:10.1016/j.cardfail.2011.06.652

PMID:21962416

Abstract

INTRODUCTION

We hypothesized that discharged heart failure (HF) patients could develop clinical congestion despite adhering to prescribed diuretics, because ambulation attenuates diuretic and natriuretic responsiveness.

METHODS

We studied 9 patients aged 57 ± 13 (mean ± SD) years with New York Heart Association functional class II-III symptoms and ejection fraction <40% (28 ± 7%) and receiving furosemide (≥80 mg/d [113 ± 53 mg/d]) plus renin-angiotensin system antagonists and beta-blockade. Inulin and p-amminohippuric acid were infused to estimate glomerular filtration rate (GFR) and renal plasma flow (RPF). Furosemide was administered intravenously at 75% of the usual oral morning dose. Participants were randomized to supine (90 minutes recumbancy) or upright (90 minutes sitting and treadmill walking) posture and assumed the other position on their second day. Primary outcome variables were urine volume and sodium excretion 90 minutes after furosemide.

RESULTS

On the upright, compared with the supine, day, urine volume (792 ± 484 vs 1,290 ± 503 mL; P = .02) and sodium (79 ± 55 vs 141 ± 61 mmol; P < .01) were attenuated, whereas plasma norepinephrine (4.4 ± 2.7 vs 2.3 ± 1.8 mmol/L; P = .01) and renin (327 ± 250% of supine; P < .01) were augmented. Urinary K+, mean pressure, GFR, and RPF were similar.

CONCLUSIONS

Activation of the sympathetic nervous system and renin-angiotensin axis by upright ambulation may attenuate diuresis and natriuresis by increasing proximal tubular reabsorption of sodium and water.

摘要

简介

我们假设即使心力衰竭（HF）患者坚持服用处方利尿剂，仍可能会出现临床充血，因为活动会减弱利尿剂和利钠肽的反应性。

方法

我们研究了 9 名年龄在 57 ± 13 岁（平均值 ± 标准差）的患者，这些患者具有纽约心脏协会功能 II-III 级症状，射血分数 <40%（28 ± 7%），并接受呋塞米（≥80 mg/d [113 ± 53 mg/d]）加肾素-血管紧张素系统拮抗剂和β受体阻滞剂治疗。通过输注菊粉和对氨基马尿酸来估计肾小球滤过率（GFR）和肾血浆流量（RPF）。静脉内给予呋塞米，剂量为常规口服早晨剂量的 75%。参与者被随机分配到仰卧位（90 分钟卧位）或直立位（90 分钟坐姿和跑步机步行），并在第二天采取另一种姿势。主要观察变量是呋塞米给药后 90 分钟的尿量和钠排泄量。

结果

与仰卧位相比，直立位时，尿量（792 ± 484 比 1,290 ± 503 mL；P =.02）和钠（79 ± 55 比 141 ± 61 mmol；P <.01）减少，而血浆去甲肾上腺素（4.4 ± 2.7 比 2.3 ± 1.8 mmol/L；P =.01）和肾素（327 ± 250%仰卧位；P <.01）增加。尿 K+、平均压、GFR 和 RPF 相似。