Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
J Am Coll Cardiol. 2012 Jun 12;59(24):2145-53. doi: 10.1016/j.jacc.2011.10.910.
Congestion and volume overload are the hallmarks of acute decompensated heart failure (ADHF), and loop diuretics have historically been the cornerstone of treatment. The demonstrated efficacy of loop diuretics in managing congestion is balanced by the recognized limitations of diuretic resistance, neurohormonal activation, and worsening renal function. However, the recently published DOSE (Diuretic Optimization Strategies Evaluation) trial suggests that previous concerns about the safety of high-dose diuretics may not be valid. There has been a growing interest in alternative strategies to manage volume retention in ADHF with improved efficacy and safety profiles. Peripheral venovenous ultrafiltration (UF) represents a potentially promising approach to volume management in ADHF. Small studies suggest that UF may allow for more effective fluid removal compared with diuretics, with improved quality of life and reduced rehospitalization rates. However, further investigation is needed to completely define the role of UF in patients with ADHF. This review summarizes available data on the use of both diuretics and UF in ADHF patients and identifies challenges and unresolved questions for each approach.
充血和容量超负荷是急性失代偿性心力衰竭（ADHF）的特征，利尿剂一直是治疗的基石。利尿剂在管理充血方面的疗效已得到证实，但利尿剂抵抗、神经激素激活和肾功能恶化的公认局限性与之平衡。然而，最近发表的 DOSE（利尿剂优化策略评估）试验表明，先前对大剂量利尿剂安全性的担忧可能没有依据。人们越来越关注替代策略，以改善 ADHF 中容量保留的疗效和安全性。外周静脉-静脉超滤（UF）代表了一种有前途的容量管理方法。小型研究表明，与利尿剂相比，UF 可能允许更有效地去除液体，从而提高生活质量并降低再住院率。然而，需要进一步的研究来完全确定 UF 在 ADHF 患者中的作用。这篇综述总结了 ADHF 患者使用利尿剂和 UF 的现有数据，并确定了每种方法的挑战和未解决的问题。
