心力衰竭中的高钾血症:阻碍最优药物治疗的暗礁  

Hyperkalemia in heart failure:a barrier to optimal drug treatment

作　　者：万宇皓 王华[1] 杨杰孚[1] Wan Yuhao;Wang Hua;Yang Jiefu(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2025年第1期81-86,共6页Chinese Journal of Geriatrics

基　　金：首都卫生发展科研专项(2022-1-4052)。

摘　　要：心力衰竭(心衰)是严重危及患者生命的临床综合征。肾素-血管紧张素-醛固酮系统抑制剂(RAASi)是射血分数下降型心衰的基石治疗药物,改善患者预后。高钾血症是心衰常见的并发症,同时也是RAASi使用的常见不良反应之一,在临床实践中导致一部分心衰患者RAASi药物撤药或减量。高钾血症自身还是其造成的RAASi药物剂量不足导致心衰患者不良预后存在争论。本文结合近年国内外心衰合并高钾血症研究,围绕高钾血症及RAASi用药模式对心衰患者临床结局的影响,讨论心衰中高钾血症管理策略。Heart failure(HF)is a clinical syndrome that poses a significant threat to patient lives.Renin-angiotensin-aldosterone system inhibitors(RAASi)represent a cornerstone therapy for heart failure with reduced ejection fraction,enhancing patient prognosis.Hyperkalemia is a prevalent complication of HF and a common adverse effect associated with the use of RAASi,often resulting in the withdrawal or dose reduction of these medications in certain heart failure patients during clinical practice.A debate exists regarding whether hyperkalemia itself,or the insufficient dosing of RAASi due to hyperkalemia,contributes to poor outcomes in HF patients.This article reviews recent domestic and international research on HF associated with hyperkalemia and discusses the effects of hyperkalemia and RAASi treatment patterns on the clinical outcomes of HF patients,while exploring strategies for managing hyperkalemia in this population.

关 键 词：心力衰竭 高钾血症 肾素-血管紧张素-醛固酮系统抑制剂 

分 类 号：R541.6[医药卫生—心血管疾病] R589.4[医药卫生—内科学]