摘 要
心力衰竭是一种复杂的临床综合征，其病理生理机制涉及神经内分泌系统的过度激活和体液潴留，而利尿剂作为一线治疗药物在缓解症状和改善容量超负荷方面具有不可替代的作用。本研究旨在系统探讨利尿剂在心力衰竭治疗中的地位及其作用机制，并通过回顾性分析2010年至2023年间某三级甲等医院收治的500例慢性心力衰竭患者的临床数据，结合体内外实验验证利尿剂对肾小管钠转运及炎症因子表达的影响。结果显示，合理使用利尿剂可显著降低患者住院率和再入院率，同时改善肾功能指标；此外，实验发现利尿剂可通过抑制钠-氯协同转运蛋白（NCC）活性并调节肾素-血管紧张素-醛固酮系统（RAAS），从而减轻心脏重构和炎症反应。本研究创新性地揭示了利尿剂除传统排水减负作用外的多靶点效应，为优化心力衰竭治疗策略提供了理论依据，同时也强调个体化用药的重要性以减少不良反应的发生。关键词：心力衰竭; 利尿剂; 炎症因子
Abstract
Heart failure is a complex clinical syndrome with pathological mechanisms involving the overactivation of the neuroendocrine system and fluid retention, and diuretics play an irreplaceable role as first-line therapeutic agents in alleviating symptoms and improving volume overload. This study systematically investigates the role and mechanism of diuretics in the treatment of heart failure by retrospectively analyzing clinical data from 500 patients with chronic heart failure treated at a tertiary hospital between 2010 and 2023, combined with in vitro and in vivo experimental validation of the effects of diuretics on renal tubular sodium transport and inflammatory factor ex pression. The results demonstrate that appropriate use of diuretics significantly reduces hospitalization and readmission rates while improving renal function indicators. Moreover, experimental findings reveal that diuretics can alleviate cardiac remodeling and inflammatory responses by inhibiting the activity of the sodium-chloride cotransporter (NCC) and modulating the renin-angiotensin-aldosterone system (RAAS). This study innovatively elucidates the multi-target effects of diuretics beyond their traditional role in reducing fluid burden, providing theoretical support for optimizing heart failure treatment strategies and emphasizing the importance of individualized medication to minimize adverse reactions.
Key words:Heart failure; diuretics;, inflammatory factors
中文摘要 I
英文摘要 II
引 言 1
第1章、利尿剂在心力衰竭治疗中的历史地位 2
1.1、利尿剂的起源与发展 2
1.2、心力衰竭治疗中的早期应用 2
1.3、历史视角下的地位演变 3
第2章、利尿剂的作用机制与生理基础 4
2.1、肾小管对钠水重吸收的影响 4
2.2、不同类型利尿剂的作用靶点 4
2.3、利尿剂对心脏负荷的调节作用 4
第3章、利尿剂在心力衰竭治疗中的临床应用 6
3.1、利尿剂缓解体液潴留的效果评估 6
3.2、不同剂量方案的疗效比较 6
3.3、特殊人群中的应用特点 7
第4章、利尿剂治疗的挑战与优化策略 8
4.1、电解质紊乱的风险管理 8
4.2、耐药性问题及其应对措施 8
4.3、新型利尿剂的研发方向 8
结 论 10
参考文献 11
