Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, LT-08406, Vilnius, Lithuania.
Heart Fail Rev. 2019 Jan;24(1):17-30. doi: 10.1007/s10741-018-9735-7.
Loop diuretics remain the cornerstone of congestion management in contemporary chronic heart failure care. However, their use is not supported by high quality data, and there is doubt about the safety in the outpatient heart failure setting. Still, congestion is related to a worse outcome, and there is general consensus among experts that congestion should not be tolerated in heart failure patients. Recommendations in international guidelines, regarding decongestion strategies in chronic heart failure, are limited. Thus, there is an emerging need for clinical decision-making support about the best strategy for using loop diuretics and decongestion in the chronic setting. The present review provides a comprehensive overview over the evidence of chronic loop diuretic use. Strategies for the assessment of congestion in the outpatient setting and decongestion algorithm are provided to assist health care specialists in delivering high-quality heart failure care.
在当代慢性心力衰竭治疗中，袢利尿剂仍然是管理充血的基石。然而，它们的使用并没有高质量的数据支持，并且在门诊心力衰竭环境下的安全性也存在疑问。尽管如此，充血与更差的预后相关，心力衰竭专家普遍认为充血在心力衰竭患者中不应被容忍。国际指南中关于慢性心力衰竭去充血策略的建议是有限的。因此，对于慢性心力衰竭中使用袢利尿剂和去充血的最佳策略，临床决策支持有了新的需求。本综述全面概述了慢性使用袢利尿剂的证据。提供了门诊环境下充血评估和去充血算法的策略，以帮助医疗保健专家提供高质量的心力衰竭护理。
