In the management of heart failure, diuretics are cornerstones for mitigating fluid retention and dyspnea. Diuretic resistance compromises efficacy, driving disease recurrence or progression. Thus, managing diuretic resistance is critical for optimizing treatment. However, existing evidence is fragmented and contentious, with no standardized clinical guidelines available.

To analyze and summarize the evidence related to the management of diuretic resistance in patients with heart failure, providing references for clinical practice.

Based on the "6S" model of evidence resources, relevant evidence regarding the management of diuretic resistance in heart failure patients was retrieved from UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Joanna Briggs Institute (JBI) Collaboration Centre Library, American Heart Association, Medlive.cn, MedSci, CNKI, Wanfang Data, VIP, CBM, Web of Science, PubMed, Embase, CINAHL, and Cochrane Library, with the search period spanning from January 1, 2015, to March 20, 2025. The literatures included underwent screening, quality assessment, data extraction, and summarization.

A total of 31 articles were included, including 6 guidelines, 5 clinical decision-making documents, 5 expert consensuses, 13 systematic reviews, and 2 randomized controlled trials. Among these, 1 guideline was rated as Grade A, 5 as Grade B, and the remaining 25 articles showed rigorous study designs with overall high quality. 56 pieces of evidence were synthesized across eight themes: diuretic response assessment, optimization of loop diuretic regimens, combining with other diuretics, hemodynamic improvement, integrated traditional Chinese and Western medicine treatment, non-pharmacological interventions, management of patients with refractory end-stage heart failure, and key points of treatment contraindications and monitoring.

This study focuses on 8 themes in patients with heart failure and diuretic resistance: diuretic response assessment, loop diuretic regimen optimization, combination with other diuretics, hemodynamic improvement, integrated Chinese and Western medicine therapy, non-pharmacological treatment, management of patients with refractory end-stage heart failure, and treatment contraindications and monitoring key points. It summarizes evidence on initial screening, medication optimization, and comprehensive non-pharmacological interventions, providing a reference for healthcare providers to manage such patients efficiently.

利尿剂是心力衰竭治疗中缓解液体潴留、改善呼吸困难等症状的基石药物，而利尿剂抵抗会削弱治疗效果，导致病情反复甚至恶化。因此，科学管理利尿剂抵抗是优化心力衰竭治疗的关键。但目前其证据内容广泛分散、存在争议，临床缺少科学、规范的实践指导方案。

分析并总结心力衰竭患者利尿剂抵抗管理的相关证据，为临床实践提供借鉴。

按照循证实践"6S"模型，检索UpToDate、BMJ Best Practice、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网、澳大利亚JBI循证卫生保健研究中心数据库、美国心脏协会、医脉通、梅斯医学、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、Web of Science、PubMed、Embase、CINAHL、Cochrane Library中有关心力衰竭患者利尿剂抵抗管理的相关证据，检索时限为2015-01-01—2025-03-20。由2名研究者独立对纳入文献进行筛选、质量评价、提取和汇总。

共纳入31篇文献，包含6篇指南、5篇临床决策、5篇专家共识、13篇系统评价及2篇随机对照试验，其中1篇指南推荐等级为A级，5篇指南推荐等级为B级，其余25篇文献研究设计严谨，整体质量较高。从利尿剂反应评估、袢利尿剂方案优化、联合其他种类利尿剂、改善血流动力学、中西医结合治疗、非药物治疗、难治性终末期心力衰竭患者管理、治疗禁忌与监测要点8个主题汇集56条证据，其中1级14条、2级6条、3级6条、5级30条。

本研究围绕心力衰竭合并利尿剂抵抗患者的利尿剂反应评估、袢利尿剂方案优化、联合其他种类利尿剂、改善血流动力学、中西医结合治疗、非药物治疗、难治性终末期心力衰竭患者管理及治疗禁忌与监测要点8个主题，梳理了初期筛查、优化用药方案与非药物综合干预证据，为医护人员高效管理此类患者提供参考。