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非传统利尿剂在慢性心力衰竭加重患者中的应用进展

Application progress of non-traditional diuretics in patients with exacerbation of chronic heart failure

  • 摘要: 袢利尿剂是缓解心力衰竭(心衰)加重时血管内或间质充血的首选药物,但是部分心衰患者服用大量袢利尿剂后,仍表现出液体超载。目前尚无证据表明利尿剂能改善心衰患者的死亡率。脑钠肽增强药和钠-葡萄糖协同转运蛋白2抑制剂是一类有独特利钠排尿机制的新型药物,有改善神经激素活性作用,且不增加肾损伤和电解质紊乱,短期与袢利尿剂联合使用能增加尿量,长期联合使用可改善心衰患者预后,为慢性心衰加重患者管理提供了新的范式。

     

    Abstract: Loop diuretics are the cornerstone of worsening heart failure (HF) therapy. However, an important challenge faced by HF patients is that despite taking a large amount of loop diuretics, they still exhibit fluid overload. There is no enough evidence of diuretics reducing the mortality of HF patients. Brain natriuretic peptides enhancer and sodium-glucose transporter 2 inhibitors with unique natriuretic effect, can improve neurohormonal activation without increasing renal injury and electrolyte disturbance. Combined with loop diuretics, they can increase urine volume in the short term and improve the prognosis in the long term, providing a new paradigm for the management of worsening HF.

     

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