Taylor S H
Z Kardiol. 1985;74 Suppl 2:2-12.
Diuretics are the mainstay of drug therapy in the treatment of many cardiovascular disorders. However, perusal of knowledge of their haemodynamic activities in heart failure and hypertension reveals major gaps. In left ventricular failure complicating acute myocardial infarction, intravenous frusemide reduces the elevated left heart filling pressure with little change in systemic blood pressure, heart rate or cardiac output, and restores the ability of the left heart to handle an acute increase in filling volume. But there is little knowledge of the haemodynamic effects of other intravenous diuretics, oral diuretics or diuretics other than those acting on the loop of Henle in this emergency clinical situation. Even less information is available on the haemodynamic effects of diuretics in patients in chronic heart failure. In patients with valvular heart disease, parenteral mercury and oral thiazides reduce right heart and pulmonary vascular pressures with variable (dose-dependent?) changes in cardiac output. Information on the effect of loop diuretics, the comparative effects of intravenous versus oral routes of administration and dose-response correlations are all lacking. In hypertension, the dose-blood pressure lowering response relationship of orally administered diuretics is relatively flat. The majority of information relates to oral thiazides; there is little reliable information on the anti-hypertensive efficacy of the loop diuretics. The acute and chronic effects of the majority of commonly used diuretics on cardiac and peripheral vascular functions is unexplained. More is known of their potentially adverse metabolic effects than of their possible circulatory benefits in hypertensive patients. Many unwanted side-effects of these drugs have been described; their potential importance is related directly to the disease state and doses in which they are used. In acute heart failure, their potential danger is probably minimal. In the treatment of chronic heart failure their most sinister potential is in the excessive secretion of potassium and magnesium. In hypertensive patients their long-term administration in high-doses may lead to undesirable metabolic effects that tend to offset their blood pressure lowering activity. Despite their drawbacks, diuretics continue to provide the natural first-line treatment of choice of these common cardiovascular syndromes. But more information on their mechanisms of vascular activities and the differences in non-diuretic activity between different compounds is urgently required.
利尿剂是治疗多种心血管疾病药物治疗的主要手段。然而，仔细研究其在心力衰竭和高血压中的血流动力学活性知识，会发现存在重大差距。在并发急性心肌梗死的左心室衰竭中，静脉注射呋塞米可降低升高的左心充盈压，而全身血压、心率或心输出量变化不大，并恢复左心处理充盈量急性增加的能力。但对于在这种紧急临床情况下，其他静脉利尿剂、口服利尿剂或除作用于髓袢外的利尿剂的血流动力学效应了解甚少。关于利尿剂在慢性心力衰竭患者中的血流动力学效应的信息更少。在瓣膜性心脏病患者中，胃肠外汞剂和口服噻嗪类药物可降低右心和肺血管压力，心输出量有可变（剂量依赖性？）变化。关于袢利尿剂的作用、静脉与口服给药途径的比较效应以及剂量 - 反应相关性的信息均缺乏。在高血压中，口服利尿剂的剂量 - 降压反应关系相对平缓。大多数信息与口服噻嗪类药物有关；关于袢利尿剂的抗高血压疗效几乎没有可靠信息。大多数常用利尿剂对心脏和外周血管功能的急性和慢性影响尚不清楚。与它们在高血压患者中可能的循环益处相比，人们对其潜在的不良代谢影响了解更多。这些药物有许多不良副作用已被描述；它们的潜在重要性直接与疾病状态和使用剂量有关。在急性心力衰竭中，它们的潜在危险可能最小。在慢性心力衰竭治疗中，其最严重的潜在危险在于钾和镁的过度分泌。在高血压患者中，长期大剂量使用可能导致不良代谢效应，往往会抵消其降压活性。尽管有缺点，利尿剂仍然是这些常见心血管综合征自然的一线首选治疗药物。但迫切需要更多关于其血管活性机制以及不同化合物之间非利尿活性差异的信息。
