心力衰竭合并利尿剂抵抗的诊断与药物治疗进展  

Advances in the diagnosis and pharmacological treatment of heart failure combined with diuretic resistance

作　　者：刘成帅 刘斐斐 陈玥 周育平[1] LIU Chengshuai;LIU Feifei;CHEN Yue;ZHOU Yuping(Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053,China;Institute of Clinical Basic Medicine of Chinese Medicine,China Academy of Chinese Medical Sciences;Guangdong Hospital of Traditional Chinese Medicine;Li Ka Shing Faculty of Medicine,The University of Hong Kong)

机构地区：[1]中国中医科学院广安门医院心血管科,北京100053 [2]中国中医科学院中医临床基础医学研究所 [3]广东省中医院 [4]香港大学李嘉诚医学院中医药学院

出　　处：《临床心血管病杂志》2025年第3期229-234,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81470185);中国中医科学院广安门医院所级科研基金项目(No:2022S468)。

摘　　要：目前认为心力衰竭合并利尿剂抵抗(DR)的主要诊断依据是尿钠(UNa)和尿量。患者每日静脉应用呋塞米剂量≥80 mg(或同等剂量的其他利尿剂),24 h尿量<800 mL,或钠排泄分数(FENa)<0.2%、UNa<50 mmol/L、UNa/UK<1.0,或应用一定剂量的利尿剂后,2 h UNa<50~70 mmol/L或6 h尿量<100~150 mL/h,则考虑存在DR。DR的药物治疗方案包括调整利尿剂剂量、改变用药途径、更改利尿剂种类、多种作用靶点的利尿剂联合使用等。At present,the diagnosis of diuretic resistance(DR)in heart failure(HF)is mainly based on urine sodium(UNa)level and urine volume.DR is diagnosed when patients require a daily intravenous dose of furosemide≥80 mg(or equivalent dose of other diuretics),have a 24 h urine volume<800 mL,or exhibit a sodium excretion fraction(FENa)<0.2%,UNa<50 mmol/L,and UNa/UK<1.0.Additional indicators of DR include a 2 h UNa<50-70 mEq/L or 6 h urine volume<100-150 mL/h when administered a certain dose of diuretics.The pharmacological treatment of DR includes adjusting diuretic dosage,changing the medication route,switching to a different type of diuretic,or combining multiple diuretics targeting various mechanisms.

关 键 词：心力衰竭 利尿剂抵抗 诊断 药物治疗 

分 类 号：R541.6[医药卫生—心血管疾病]