循環器ジャーナル65巻1号

2017年01月発行

特集 Clinical Scenarioによる急性心不全治療 Ⅳ．Clinical Scenario 2：体液過剰を伴う急性心不全

急性心不全治療におけるループ利尿薬の使い方

著者： 織原良行¹ 廣谷信一¹ 増山理¹

所属機関： ¹兵庫医科大学循環器内科

ページ範囲：P.66 - P.71

Point
・心不全増悪時のループ利尿薬使用には，投与量，種類，投与方法の変更を考慮する必要がある．
・ドパミン，ナトリウム利尿ペプチドの有用性をサポートするエビデンスは存在しない．
・高張食塩水の投与は，ループ利尿薬の利尿効果を強める．

参考文献

1) JCS Joint Working Group:Guidelines for treatment of acute heart failure（JCS 2011). Circulation journal 77:2157-2201, 2013

2) Schwartz S, Brater DC, Pound D, et al:Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide in patients with cirrhosis. Clin Pharmacol Ther 54:90-97, 1993

3) Stevenson LW, Tillisch JH:Maintenance of cardiac output with normal filling pressures in patients with dilated heart failure. Circulation 74:1303-1308, 1986

4) Felker GM, Lee KL, Bull DA, et al:Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797-805, 2011

5) Brisco MA, Zile MR, Hanberg JS, et al:Relevance of changes in serum creatinine during a heart failure trial of decongestive strategies:insights from the DOSE trial. J Card Fail 22:753-760, 2016

6) Giamouzis G, Butler J, Starling RC, et al:Impact of dopamine infusion on renal function in hospitalized heart failure patients:results of the Dopamine in Acute Decompensated Heart Failure（DAD-HF）Trial. J Card Fail 16:922-930, 2010

7) Triposkiadis FK, Butler J, Karayannis G, et al:Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion:the Dopamine in Acute Decompensated Heart Failure Ⅱ（DAD-HF Ⅱ）trial. Int J Cardiol 172:115-121, 2014

8) Cardinale M, Altshuler J, Testani JM:Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone. Pharmacotherapy 36:843-851, 2016

9) Shulenberger CE, Jiang A, Devabhakthuni S, et al:Efficacy and safety of intravenous chlorothiazide versus oral metolazone in patients with acute decompensated heart failure and loop diuretic resistance. Pharmacotherapy 36:852-860, 2016

10) Okuhara Y, Hirotani S, Naito Y, et al:Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure. J Card Fail 20:295-301, 2014

11) Okuhara Y, Hirotani S, Ando T, et al:Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure:a single-center retrospective cohort study. Heart Vessels 2016.