Cox Zachary L, Lenihan Daniel J
Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
J Card Fail. 2014 Aug;20(8):611-22. doi: 10.1016/j.cardfail.2014.05.007. Epub 2014 May 28.
Loop diuretics are a cornerstone of symptom management for nearly all patients with heart failure. Diuretic resistance is a clinical problem with similar presentation despite diverse and multiple etiologies. Although the exact incidence is not known, diuretic resistance occurs frequently and can increase the length of hospitalization. Despite the prevalence of loop diuretic prescription in heart failure and frequency of diuretic resistance, current heart failure guidelines provide nonspecific guidance on strategies to restore diuretic efficacy. Providers are left with many questions regarding the optimum diuretic titration strategy in the setting of diuretic resistance. In light of these highly prevalent uncertainties, we present a case vignette-structured literature review of the mechanisms of diuretic resistance and recommend therapeutic strategies based on the resistance etiology to improve diuretic response in acute decompensated heart failure.
袢利尿剂是几乎所有心力衰竭患者症状管理的基石。尽管病因多样且复杂，但利尿剂抵抗是一种具有相似表现的临床问题。虽然确切发病率尚不清楚，但利尿剂抵抗很常见，且会延长住院时间。尽管袢利尿剂在心力衰竭治疗中应用广泛，利尿剂抵抗也很常见，但目前的心力衰竭指南对恢复利尿剂疗效的策略提供的指导并不具体。在利尿剂抵抗的情况下，临床医生对于最佳利尿剂滴定策略存在诸多疑问。鉴于这些高度普遍的不确定性，我们通过病例 vignette 结构的文献综述阐述利尿剂抵抗的机制，并根据抵抗病因推荐治疗策略，以改善急性失代偿性心力衰竭患者的利尿剂反应。
