Advances in the diagnosis and pharmacological treatment of heart failure combined with diuretic resistance
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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。Abstract: 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.
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Key words:
- heart failure /
- diuretic resistance /
- diagnosis /
- pharmacological treatment
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表 1 UNa作为临床结果预测因子的部分研究
Table 1. Partial studies on UNa as a predictor of clinical outcomes
研究 测量点 例数 标准 预测价值/结果 Singh，et al(2014) 随机 52 UNa < 50 mmol/L 24 h尿量减少，不良事件增多 Ferreira，et al(2016) 第3天 100 UNa>60 mmol/L UNa/UK>2 不良事件减少 Testani，et al(2016) 1~2 h 50 UNa < 60 mmol/L 不良事件发生率升高 Luk，et al(2018) 首次排尿 103 UNa < 60 mmol/L 不良临床事件升高 Brinkley，et al(2018) 首次排尿 176 UNa < 60 mmol/L 30 d住院或急诊率升高 Collins，et al(2018) 1 h 61 UNa < 35 mmol/L 恶化性HF 
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