心力衰竭药物治疗相关高钾血症防治专家共识  

Chinese Expert Consensus on Prevention and Treatment of Hyperkalemia Related to Heart Failure Medication Therapy

作　　者：中国医师协会心血管内科医师分会 中国老年医学学会心电与心功能分会 周京敏 杨杰孚 陈牧雷[2] 李萍[3] 孙志军[4] 徐东杰[5] 徐亚妹[6] Cardiovascular Medicine Branch of Chinese Physicians Association;Electrophysiology and Cardiac Function Branch of Chinese Society of Geriatrics;ZHOU Jingmin;YANG Jiefu

机构地区：[1]不详 [2]首都医科大学附属北京朝阳医院 [3]南昌大学第二附属医院 [4]中国医科大学附属盛京医院 [5]南京医科大学第一附属医院 [6]复旦大学附属中山医院

出　　处：《中国循环杂志》2024年第6期537-546,共10页Chinese Circulation Journal

基　　金：国家重点研发计划(2018YFE0103000)。

摘　　要：肾素-血管紧张素系统抑制剂(RASi)、血管紧张素受体脑啡肽酶抑制剂(ARNI)、盐皮质激素受体拮抗剂(MRA)等是心力衰竭治疗的基石药物,也是诱发高钾血症的重要原因。发生高钾血症的心力衰竭患者死亡风险和再住院风险显著增加,而减少或停用这些药物对心力衰竭患者预后的危害超过高钾血症带来的风险。为了更好地降低心力衰竭人群中高钾血症的发生风险并规范管理,由中国医师协会心血管内科医师分会、中国老年医学学会心电与心功能分会组织相关专家,参考国内外最新高钾血症管理指南/共识意见及临床研究结果,结合我国国情和临床实践制定了本共识,主要内容包括心力衰竭患者中高钾血症的流行病学,心力衰竭治疗药物的规范应用,心力衰竭患者合并高钾血症高危人群的识别、监测、随访及预防,降钾用药策略等,以期为临床医师早期预防和管理心力衰竭药物治疗相关高钾血症提供临床依据。Renin-angiotensin system inhibitors,angiotensin receptor neprilysin inhibitors,and mineralocorticoid receptor antagonists are the cornerstone medications for the treatment of heart failure,but they are also major causes of hyperkalemia.Patients with heart failure who develop hyperkalemia have an increased risk of mortality and rehospitalization.Reducing or discontinuing these drugs are associated with higher risk of adverse outcome than hyperkalemia itself.To reduce hyperkalemia risk in patients with heart failure and standardize the management,experts from Cardiovascular Medicine Branch of Chinese Physicians Association and Electrophysiology and Cardiac Function Branch of Chinese Society of Geriatrics developed this consensus,referring to the latest domestic and international guidelines/consensus opinions on hyperkalemia management and clinical research results,and considering the national situation and clinical practice in China.The consensus mainly includes the epidemiology of hyperkalemia in heart failure patients,standardized the use of heart failure treatment drugs,identification,monitoring,follow-up,and prevention of heart failure patient at high risk of hyperkalemia,as well as application strategies of potassium-lowering medication,aiming to provide clinicians with guidance for early prevention and treatment on heart failure medication-related hyperkalemia.

关 键 词：心力衰竭 肾素-血管紧张素系统抑制剂 盐皮质激素受体拮抗剂 药物治疗 高钾血症 共识 

分 类 号：R54[医药卫生—心血管疾病]