心力衰竭患者利尿剂抵抗的研究进展  

Research advances in diuretic resistance in patients with heart failure

作　　者：王丹妮 冯津萍[3] 冯超[3] 陈树涛[3] WANG Dan-ni;FENG Jin-ping;FENG Chao;CHEN Shu-tao(Thoracic Clinical College,Tianjin Medical University,Tianjin 300222,China;Graduate School of Medicine,Tianjin Medical University;Department of CICU,Tianjin Chest Hospital)

机构地区：[1]天津医科大学胸科临床学院,300222 [2]天津医科大学研究生院 [3]天津市胸科医院CICU

出　　处：《天津医药》2020年第4期347-352,共6页Tianjin Medical Journal

基　　金：心脏康复与代谢治疗研究基金资助项目(CCA-CRMT-1805)。

摘　　要：心力衰竭是各种心脏疾病发展的终末阶段,近年来我国心衰患病率逐渐升高,正在成为21世纪最重要的心血管病症。心力衰竭的药物治疗主要包括两个方面,一是延缓疾病进展,主要包括内啡肽酶抑制剂(沙库巴曲缬沙坦)、血管紧张素转化酶抑制剂(A CEI)、血管紧张素Ⅱ受体拮抗剂(A RB)、β受体阻断剂、醛固酮受体拮抗剂等药物;二是改善症状如呼吸困难、水肿等,主要包括利尿剂、血管扩张剂等。考虑到充血在心力衰竭中的关键作用,利尿剂是心力衰竭治疗的基石,然而临床上由于各种原因,导致20%~30%患者产生利尿剂抵抗,使心衰患者的治疗效果明显降低。本文就利尿剂抵抗的定义、发病机制及其治疗策略进行综述。Heart failure is the final stage of the development of various heart diseases.In recent years,the prevalence of heart failure in China has gradually increased and is becoming the most important cardiovascular disease in the 21 st century.Diuretics are the key and basis for the treatment of heart failure.The drug treatment of heart failure mainly includes two aspects,one is to delay the progress of the disease,mainly including endorphin inhibitor(sakutravalsartan),angiotensin converting enzyme inhibitor(ACEI),angiotensin Ⅱ receptor antagonist(ARB),beta blocker,aldosterone receptor antagonist and other drugs;the other is to improve symptoms such as dyspnea and edema,including diuretics and vasodilators.Considering the key role of congestion in heart failure,diuretics are the cornerstone of heart failure treatment.However,due to various reasons,25%-30%of the patients have diuretic resistance,which significantly reduces the therapeutic effect in patients with heart failure.This article reviews the definition,pathogenesis and therapeutic strategy of diuretic resistance.

关 键 词：心力衰竭 利尿药 渗透性 利尿剂抵抗 

分 类 号：R541.61[医药卫生—心血管疾病]