Aspromonte Nadia, Ria Paolo, Bonello Monica
Dipartimento Cardiovascolare, Ospedale San Filippo Neri, Roma, Italy.
G Ital Nefrol. 2012 Jan-Feb;29(1):33-43.
Heart failure is one of the major causes of hospitalization in Italy and the Western world and is characterized by different pathophysiological conditions and multiple precipitating factors. The state of congestion, which is the main clinical presentation on admission, is treated in the majority of cases with diuretic therapy until hemodynamics are normalized and symptoms resolved. Treatment with loop diuretics, although widely used in the treatment of chronic heart failure, may result in diuretic resistance, electrolyte and volemic imbalance, neurohormonal activation, and worsening renal function. In this article the mechanisms of diuretic resistance and the strategies used to treat it and to optimize diuretic therapy of heart failure are discussed.
心力衰竭是意大利和西方世界住院治疗的主要原因之一，其特征是不同的病理生理状况和多种诱发因素。充血状态是入院时的主要临床表现，在大多数情况下通过利尿剂治疗，直到血流动力学恢复正常且症状缓解。袢利尿剂虽然广泛用于治疗慢性心力衰竭，但可能导致利尿剂抵抗、电解质和容量失衡、神经激素激活以及肾功能恶化。本文讨论了利尿剂抵抗的机制以及用于治疗利尿剂抵抗和优化心力衰竭利尿剂治疗的策略。
