急性心力衰竭的当代减充血策略。

IF 2.8 3区 医学 Q2 UROLOGY & NEPHROLOGY
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引用次数: 0

摘要

充血是心力衰竭患者入院的主要原因,也是决定患者预后的关键因素。尽管静脉注射襻利尿剂仍是急性心力衰竭患者的主要药物,但治疗反应却不尽相同,相当一部分患者出院时仍残留高血容量血症。在这种情况下,尿钠排泄量作为襻利尿剂反应的标志和预后的标志受到了关注,这可能是指导治疗的有用临床工具。为了改善利尿剂的反应性和清除多余的液体,人们探索了几种去充血策略。通过联合利尿剂疗法对肾小球进行序贯阻断是最常用的方法之一,可提高利尿效果并对抗利尿剂耐药性。在本文中,我将概述当代的减充血方法,并讨论使用附加利尿剂疗法的临床数据。我还讨论了通过体外超滤来机械清除多余液体的方法,并简要回顾了具有里程碑意义的研究结果。最后,我简要概述了目前正在研究的策略,这些策略在这种情况下可能会有所帮助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Contemporary Decongestive Strategies in Acute Heart Failure

Congestion is the primary driver of hospital admissions in patients with heart failure and the key determinant of their outcome. Although intravenous loop diuretics remain the predominant agents used in the setting of acute heart failure, the therapeutic response is known to be variable, with a significant subset of patients discharged from the hospital with residual hypervolemia. In this context, urinary sodium excretion has gained attention both as a marker of response to loop diuretics and as a marker of prognosis that may be a useful clinical tool to guide therapy. Several decongestive strategies have been explored to improve diuretic responsiveness and removal of excess fluid. Sequential nephron blockade through combination diuretic therapy is one of the most used methods to enhance natriuresis and counter diuretic resistance. In this article, I provide an overview of the contemporary decongestive approaches and discuss the clinical data on the use of add-on diuretic therapy. I also discuss mechanical removal of excess fluid through extracorporeal ultrafiltration with a brief review of the results of landmark studies. Finally, I provide a short overview of the strategies that are currently under investigation and may prove helpful in this setting.

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来源期刊
Seminars in nephrology
Seminars in nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
0.00%
发文量
27
审稿时长
6-12 weeks
期刊介绍: Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.
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