利尿劑在心力衰竭中的應(yīng)用(編輯修改稿)
2024-11-04 13:10 本頁面
【文章內(nèi)容簡(jiǎn)介】 輸注袢利尿劑。 d. 短期加用小劑量多巴胺增加腎血流（ 100 250微克 /分） 無效者，超濾。 2020/01/07 攀 利尿 劑的 使用 劑量 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
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