利尿剂在心力衰竭中的应用

利尿剂在心力衰竭中的应用内容摘要：

输注袢利尿剂。 d. 短期加用小剂量多巴胺增加肾血流（ 100 250微克 /分） 无效者，超滤。 2020/01/07 攀 利尿 剂的 使用 剂量 Usual maximal does Furosemide: 4080 mg CHF + Renal failure Furosemide 200 mg CHF + diuretic resistance Continuous infusion Furosemide: 4080 mg / hr Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE) G. Michael Felker, MD, MHS, FACC Christopher M. O’Connor, MD, FACC Study Chair: Eugene Braunwald, MD NHLBI Heart Failure Clinical Research Network Aims • To evaluate the safety and efficacy of various initial strategies of furosemide therapy in patients with ADHF – Route of administration: • Q12 hours bolus • Continuous infusion – Dosing • Low intensification (1 x oral dose) • High intensification ( x oral dose) Acute Heart Failure (1 symptom AND 1 sign) 24 hours after admission 2x2 factorial randomization Low Dose (1 x oral) Q12 IV bolus 48 hours 1) Change to oral diuretics 2) continue current strategy 3) 50% increase in dose Coprimary endpoints High Dose ( x oral) Q12 IV bolus Low Dose (1 x oral) Continuous infusion High Dose ( x oral) Continuous infusion 72 hours Study Design Clinical endpoints 60 days CoPrimary Endpoints • Efficacy: – Patient Global Assessment by visual analog scale over 72 hours using area under the curve • Safety: – Change in creatinine from baseline to 72 hours Secondary Endpoints • Change in weight over 24, 48, 72, 96 hours • Freedom from signs and symptoms of congestion at 72 hours • Bivariate vector of change in creatinine and weight at 72 hours • Death, rehospitalization, or ED visit within 60 days Inclusion Criteria • ≥18 years old • Prior clinical diagnosis of heart failure with daily home use of oral loop diuretic for at least one month • Daily oral dose of furosemide ≥ 80 mg and ≤240 mg • within 24 hours of hospital admission need for IV loop diuretics for。