Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Divison of Cardiology, Duke University School of Medicine, Durham, North Carolina.
Oregon Clinical & Translational Research Institute, Portland, Oregon; Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon.
J Am Coll Cardiol. 2020 Mar 17;75(10):1178-1195. doi: 10.1016/j.jacc.2019.12.059.
Expansion of extracellular fluid volume is central to the pathophysiology of heart failure. Increased extracellular fluid leads to elevated intracardiac filling pressures, resulting in a constellation of signs and symptoms of heart failure referred to as congestion. Loop diuretics are one of the cornerstones of treatments for heart failure, but in contrast to other therapies, robust clinical trial evidence to guide the use of diuretics is sparse. A nuanced understanding of renal physiology and diuretic pharmacokinetics is essential for skillful use of diuretics in the management of heart failure in both the inpatient and outpatient settings. Diuretic resistance, defined as an inadequate quantity of natriuresis despite an adequate diuretic regimen, is a major clinical challenge that generally portends a poor prognosis. In this review, the authors discuss the fundamental mechanisms and physiological principles that underlie the use of diuretic therapy and the available data on the optimal use of diuretics.
细胞外液容量扩张是心力衰竭病理生理学的核心。细胞外液增加会导致心内充盈压升高，从而导致一系列心力衰竭的体征和症状，称为充血。袢利尿剂是心力衰竭治疗的基石之一，但与其他疗法不同，指导利尿剂使用的强有力的临床试验证据很少。熟练地在心力衰竭的住院和门诊管理中使用利尿剂，需要对肾脏生理学和利尿剂药代动力学有细致的理解。利尿剂抵抗是指尽管使用了适当的利尿剂方案，但仍存在排钠不足，这是一个主要的临床挑战，通常预示着预后不良。在这篇综述中，作者讨论了利尿剂治疗的基本机制和生理学原理，以及关于最佳利尿剂使用的现有数据。
