「强心、利尿、扩血管」，口诀简单，但非常多人都用错了
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">「强心、利尿、扩血管」，心衰用药三板斧耳熟能详，但临床应用却问题不少，急性心衰<span style="color: black;">到底</span>该<span style="color: black;">怎样</span>规范用药？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01. 利尿剂</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">有液体潴留证据的急性心衰<span style="color: black;">病人</span>均应<span style="color: black;">运用</span>利尿剂。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">呋塞米宜先静脉注射 20 ~ 40 mg，之后可静脉滴注 5 ~ 40 mg/h，其总剂量在起初 6 h 不超过 80 mg，起初 24 h 不超过 160 mg。<span style="color: black;">也</span>可应用托拉塞米 10 ~ 20 mg 静脉注射。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>平时<span style="color: black;">运用</span>袢利尿剂治疗，最初静脉剂量应不<span style="color: black;">少于</span><span style="color: black;">长时间</span>每日所用剂量。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重视</span>事项：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1）需监测<span style="color: black;">病人</span>症状、尿量、肾功能和电解质。<span style="color: black;">按照</span><span style="color: black;">病人</span>症状和临床状态<span style="color: black;">调节</span>剂量和疗程。有低灌注表现的<span style="color: black;">病人</span>应在纠正后再<span style="color: black;">运用</span>利尿剂。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2）利尿剂反应<span style="color: black;">不良</span>或抵抗的处理：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">① <span style="color: black;">增多</span>袢利尿剂剂量；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">② 静脉推注联合<span style="color: black;">连续</span>静脉滴注：静脉<span style="color: black;">连续</span>和多次应用可避免<span style="color: black;">由于</span>袢利尿剂浓度下降<span style="color: black;">导致</span>的钠水重吸收；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③ 2 种及以上利尿剂联合<span style="color: black;">运用</span>；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">④ 应用<span style="color: black;">增多</span>肾血流的<span style="color: black;">药品</span>，如小剂量多巴胺或重组人利钠肽；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">⑤ 常规利尿剂治疗效果<span style="color: black;">不良</span>，伴低钠血症可加用托伐普坦；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">⑥ 超滤治疗或其他肾脏替代治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3）可诱发强心苷类和延长动作电位时程的抗<span style="color: black;">心率</span>失常药<span style="color: black;">出现</span><span style="color: black;">心率</span>失常。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4）与非甾体抗炎药、苯妥英钠合用，可减弱呋塞米的利尿<span style="color: black;">功效</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">02. 血管扩张药</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-eda584d5e5bee4c8a1e5f9fed3bbdc0b_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重视</span>事项：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1）收缩压 > 110 mmHg 的<span style="color: black;">病人</span><span style="color: black;">一般</span>可安全<span style="color: black;">运用</span>；收缩压在 90 ~ 110 mmHg，应<span style="color: black;">小心</span><span style="color: black;">运用</span>；收缩压 < 90 mmHg，禁忌<span style="color: black;">运用</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2）有<span style="color: black;">显著</span>二尖瓣或主动脉瓣狭窄的<span style="color: black;">病人</span>应慎用。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3）射血分数<span style="color: black;">保存</span>的心衰<span style="color: black;">病人</span>因对容量更加<span style="color: black;">敏锐</span>，<span style="color: black;">运用</span>血管扩张药应<span style="color: black;">小心</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4）应用过程中需密切监测血压，<span style="color: black;">按照</span>血压<span style="color: black;">状况</span><span style="color: black;">调节</span>合适的维持剂量。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">03. 正性肌力药</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正性肌力药适用于症状性低血压（收缩压 < 90 mmHg）伴低心排和/或组织器官低灌注的<span style="color: black;">病人</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-81197c988f672c1b959032434fef87c9_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重视</span>事项：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1）症状性低血压伴低心排或低灌注时应尽早<span style="color: black;">运用</span>，而当器官灌注恢复和/或淤血减轻时则应尽快停用。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2）<span style="color: black;">药品</span>的剂量和静脉滴注速度应<span style="color: black;">按照</span><span style="color: black;">病人</span>的临床反应作<span style="color: black;">调节</span>，强调个体化治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3）此类<span style="color: black;">药品</span>可诱发心动过速、<span style="color: black;">心率</span>失常、心肌缺血等，用药<span style="color: black;">时期</span>应<span style="color: black;">连续</span>心电、血压监测。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4）血压正常、<span style="color: black;">没</span>器官和组织灌注不足的急性心衰<span style="color: black;">病人</span>不宜<span style="color: black;">运用</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5）因低血容量或其他可纠正<span style="color: black;">原因</span><span style="color: black;">引起</span>的低血压<span style="color: black;">病人</span>，需先去除这些<span style="color: black;">原因</span>再权衡<span style="color: black;">运用</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6）与维拉帕米、地尔硫䓬、胺碘酮合用可使去乙酰毛花苷血药浓度<span style="color: black;">上升</span>，<span style="color: black;">导致</span>严重心动过缓；螺内酯可延长去乙酰毛花苷的半衰期，合用时需<span style="color: black;">调节</span>剂量和给药时间，密切监测血药浓度。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">7）洋地黄类<span style="color: black;">药品</span>与排钾利尿药合用，可<span style="color: black;">导致</span>低血钾而致洋地黄中毒，应<span style="color: black;">重视</span><span style="color: black;">弥补</span>钾，使血钾浓度<span style="color: black;">处在</span>正常水平。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">04. 血管收缩药 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">适用于已应用正性肌力<span style="color: black;">药品</span>后仍<span style="color: black;">显现</span>心源性休克或合并<span style="color: black;">显著</span>低血压状态的<span style="color: black;">病人</span>。心源性休克时首选去甲肾上腺素维持收缩压。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-2bc42869d2f6686cc26ed623f0cacf14_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重视</span>事项：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">血管收缩药<span style="color: black;">拥有</span>正性肌力活性，<span style="color: black;">亦</span>有相应的不良反应，用药过程中应密切监测，当器官灌注恢复和/或循环淤血减轻时应尽快停用。</p>
一看到楼主的气势，我就觉得楼主同在社区里灌水。 感谢楼主分享，祝愿外链论坛越办越好！
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