循環器ジャーナル66巻1号

2018年01月発行

特集 循環器診療　薬のギモン—エキスパートに学ぶ薬物治療のテクニック Ⅰ．心不全診療でのギモン

急性心不全の利尿薬は一律フロセミド20mg静脈投与ではいけないのか？

著者： 土肥薫¹

所属機関： ¹三重大学医学部附属病院循環器内科

ページ範囲：P.6 - P.12

Point
・うっ血所見を呈するすべての急性心不全患者に対し，利尿薬の静脈投与はクラス1の適応である．
・“Door-to-Furosemide”の短縮が良好な院内予後に関連する．
・初期治療ではフロセミド20mg静脈投与がスタンダードだが，慢性心不全患者の急性増悪時には，治療歴や利尿薬内服量を勘案して初期投与量を決定する．
・フロセミドのボーラス投与と持続投与の効果や安全性は，ほぼ同等とされている．
・選択的バソプレシンV₂受容体拮抗薬であるトルバプタンの有用性に関する知見も多く積み上げられ，治療選択の幅が広がった．

参考文献

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