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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
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・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．
・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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