《急诊每日一题》急性高血压心源性肺水肿与速尿2021年1月

Question 问题：

The mainstay of treatment of acute hypertensive cardiogenic pulmonary edema is high dose nitrates. Why is furosemide not recommended in the initial resuscitation of such patients? 

急性高血压心源性肺水肿的核心治疗是高浓度硝酸盐（硝普钠，硝酸甘油）。为什么不建议在开始抢救这些患者时用速尿？

Answer 答案：

Furosemide causes activation of the renin-angiotensin-aldosterone neurohormonal pathway, acutely leading to increased plasma catecholamines, vasoconstriction, increased LV filling pressure and LV dysfunction. 

速尿会激活肾素-血管紧张素-醛固酮神经内分泌路径，快速导致血浆儿茶酚胺升高，血管收缩，左心室充盈压升高，和左心室衰竭。

参考文献：

Am J EM, epub, 12/13/20