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袢利尿剂在充血性心力衰竭治疗中发挥了重要作用,但在部分患者会出现利尿剂抵抗,使心力衰竭的症状加重、预后变差。克服利尿剂抵抗的方法之一是联合噻嗪类利尿剂,产生“连续肾封锁”的利尿协同作用。联合一种噻嗪类利尿剂可双倍增加每日尿钠排泄,使体质量减轻、水肿消退,但也会诱导严重的低钾血症、低血压、低钠血症及肾功能恶化。本综述主要简介利尿剂抵抗的原因和对策,并探讨袢利尿剂和噻嗪类利尿剂的联合应用的可行性及常见不良反应和临床注意事项。
袢 diuretics play an important role in the treatment of congestive heart failure, but in some patients there will be diuretic resistance, so that the symptoms of heart failure increased, the prognosis worsened. One way to overcome the diuretic resistance is to combine thiazide diuretics with diuretic synergy resulting in a “continuous renal blockade.” Combined with a thiazide diuretic can double daily urinary sodium excretion, so that weight loss, edema subsided, but also induce serious hypokalemia, hypotension, hyponatremia and renal dysfunction. This review summarizes the causes and countermeasures of diuretic resistance and discusses the feasibility and common adverse reactions and clinical precautions of combined use of diuretics and thiazide diuretics.