从《中国心力衰竭诊断和治疗指南2018》看容量管理

Review of volume management based on 2018 Chinese Guidelines of Heart Failure

2018年10月新发布的《中国心力衰竭诊断和治疗指南2018》在心力衰竭(心衰)的分类、诊断标准、预防、药物治疗、非药物治疗等方面进行了更新。容量负荷过重/淤血在心衰进展中起重要作用,无症状的血流动力学淤血如不断发展,可成为有症状的临床淤血,是导致心衰患者住院的主要原因。本文围绕2018年指南对心衰的容量管理进行了综述,内容包括容量状态和淤血的评估、评估时机,液体和钠的摄入管理,药物治疗以及血液超滤治疗。药物治疗中重点阐述了利尿剂,包括传统利尿剂以及新型血管加压素V2受体拮抗剂的应用。

The new 2018 Chinese Guidelines of Heart Failure published in October 2018 updated the classification,diagnostic criteria,prevention,drug treatment and non-drug treatment of heart failure.Volume overload/congestion plays an important role in the development of heart failure.Asymptomatic hemodynamic congestion can become symptomatic clinical congestion,which is the main cause of hospitalization of patients with heart failure.This paper reviews volume management of heart failure based on 2018 guidelines,including the assessment of volume status and congestion,timing of assessment,intake management of liquid and sodium,drug treatment and blood ultrafiltration therapy.Drug therapy focuses on the application of diuretics,including traditional diuretics and new vasopressin V2 receptor antagonists.