中医药治疗慢性心力衰竭合并利尿剂抵抗的研究进展

Research Progress of Traditional Chinese Medicine in Treating Chronic Heart Failure Complicated with Diuretic Resistance

摘要: 慢性心力衰竭(chronic heart failure, CHF)是各种原因导致的心脏负荷过重，心肌收缩力下降引起一种临床综合征，具有较高的发病率和死亡率。避免液体超负荷的管理是控制心力衰竭病情恶化的治疗基石，对于那些存在液体潴留的心力衰竭病人来说，利尿剂成为了唯一能够完全控制并有效地消除液体潴留的药物选择，可通过促进尿液产生来减轻心脏负荷。然而，过度使用利尿剂极易导致利尿剂抵抗，研究显示，CHF患者中约20%~50%的心力衰竭病人表现出对利尿剂的抵抗性，并且这种抵抗性与CHF的死亡率有独立的关联。中医药作为中国传统医学的重要组成部分，对于慢性心力衰竭合并利尿剂抵抗的治疗具有理法方药兼备，疗效确切，不良反应少等独特优势。本文旨在综述近年来中医药在这一领域的研究进展。

Abstract: Chronic heart failure (CHF) is a clinical syndrome caused by excessive cardiac load and decreased myocardial contractility caused by various reasons, with high morbidity and mortality. Management to avoid fluid overload is the cornerstone of treatment to control the deterioration of heart failure. For patients with heart failure with fluid retention, diuretics are the only drugs that can fully control and effectively eliminate fluid retention, which can reduce the cardiac load by promoting urine production. However, overuse of diuretics can easily lead to diuretic resistance, which has been shown to exist in 20% to 50% of heart failure patients with CHF and is independently associated with mortality from CHF. As an important part of traditional Chinese medicine, traditional Chinese medicine (TCM) has unique advantages in the treatment of chronic heart failure combined with diuretic resistance, such as combination of principles, methods, prescriptions and medicines, precise curative effect and few adverse reactions. This paper aims to review the research progress of traditional Chinese medicine in this field in recent years.