Vasopressin antagonists in the management of heart failure

Vasopressin antagonists have been studied in a variety of clinical settings, including patients with acute and chronic heart failure. The clinical trials published to date have sought to describe the clinical and physiologic effects of these agents in an effort to prove clinical efficacy and safety. A variety of agents with varying effects on V2 and V1a vasopressin receptor subtype have been studied. They have been shown to reduce bodyweight and improve serum sodium without worsening renal function. They may also decrease the need for loop diuretic use and may be particularly useful in patients with hyponatremia in the setting of volume overload. Further studies are underway that are powered to assess for morbidity and mortality benefits. The beneficial effects have been well documented but, until outcomes are understood more fully, the use of these agents should be limited to currently approved indications. In the USA, this includes only the treatment of euvolemic hyponatremia.     

Think FIRST to treat Dilutional Hyponatremia in Patients With Heart Failure

Patients with heart failure (HF) are at risk of developing hyponatremia due to retention of fluids which dilutes serum sodium. Studies have demonstrated that health care professionals have inadequate knowledge of managing hyponatremia in patients with HF. We created a mnemonic that provides nurse practitioners with an evidence-based approach to managing hyponatremia in HF. The “FIRST” mnemonic features 5 different treatment options: Fluid restriction, Induced diuresis, Received no specific treatment for hyponatremia, Saline (isotonic and hypertonic), and Tolvaptan.     

倍他乐克治疗慢性心衰的疗效观察

目的 观察倍他乐克对慢性心衰（CHF）的临床疗效。方法 将42例CHF患者随机分为倍他乐克组22例；常规治疗组20例；其中心肌病10例，冠心病32例。倍他乐克组在常规抗心衰治疗的基础上加用倍他乐克；常规治疗组则用强心利尿ACEI常规抗心衰治疗。结果 倍他乐克组心功能明显改善，总有效率达86％，与对照组比较有显著差异（P〈0．05），平均心率较对照组明显减慢（P〈0．005）。结论 倍他乐克对慢性心衰有显著效果。     

慢性肾衰并急性左心衰36例救治体会

目的：分析探讨终末期慢性肾衰竭（CRF）并急性左心衰的发病机制及救治措施。方法：对36例各种原因所致的终末期CRF患者并急性左心衰采用药物控制血压,降低外周血管阻力,减轻心脏后负荷及采用血液透析等方法,减轻心脏前负荷,控制心衰。结果：36例患者2 286次来院救治并发急性左心衰1 144次,抢救成功1 138次,成功率99.5%。结论：终末期CRF并急性左心衰据发病机理不同,给予不同处理,关键是尽快控制血压,脱水,降低外周血管阻力和控制血容量,降低心输出量。     

左西孟坦联合多巴酚丁胺治疗急性心力衰竭

目的观察左西孟坦联合多巴酚丁胺治疗急性心力衰竭的临床疗效。方法95例急性心力衰竭患者,NYHA分级Ⅳ级且左室射血分数（LVEF）〈40％,将其按治疗方法的不同分成治疗组及对照组。治疗组（n=47）予左西孟坦联合多巴酚丁胺治疗,对照组（n=48）予左西孟坦治疗,比较2组疗效、心功能及不良反应发生情况。结果治疗组总有效率高于对照组（78．7％比60．4％,P〈0．05）。治疗后,2组LVEF、中心静脉压（CVP）及每搏输出量（SV）较治疗前显著改善（P〈0．05）;且治疗组优于对照组（P〈O．05）。2组不良反应发生率差异无统计学意义（P=0．671）。结论左西孟坦联合多巴酚丁胺治疗急性心力衰竭疗效确切,患者的心功能改善较为明显,且不良反应并未明显增多。     

乌司他丁治疗急性左心衰的临床研究

目的:评价乌司他丁(UTI)治疗急性左心衰的临床疗效及安全性.方法:将120例急性左心衰的患者随机分为治疗组62例和对照组58例,治疗组在常规抗心衰治疗的基础上给予UTI 10万U溶入0.9%氯化钠(NS)注射液10 mL中缓慢静脉注射,Q8h,对照组在常规抗心衰治疗的基础上给予安慰剂0.9%NS 10 mL缓慢静脉注射,Q8h,观察3天后两组患者的心率(HR)、呼吸(R)、血压(BP)、动脉血氧饱和度(SaO2)、心衰标志物N末端B型利钠肽原(NT-proBNT)改善情况及患者的平均住院时间和院内死亡率.结果:治疗组HR、R、BP、SaO2、NT-proBNT改善情况及患者的平均住院时间和院内死亡率均优于对照组(P<0.05).结论:UTI是辅助治疗急性左心衰安全有效的药物,建议临床推广应用.     

托伐普坦在心力衰竭容量超负荷中的应用进展

容量超负荷是急慢性心力衰竭发展的重要病理生理过程.尽管神经激素治疗在射血分数降低的心衰(heart failure with reduced ejection fraction,HFrEF)患者中可降低死亡率,但是缺乏临床试验证实以容量干预为导向的药物治疗在急性失代偿心衰或淤血症状加重的慢性心衰患者中获益.确定安全有效...     

BiPAP无创通气佐治急性左心衰竭26例临床研究

目的:观察BiPAP通气治疗急性左心衰竭的临床疗效.方法:以常规药物治疗急性左心衰竭22例为对照组,以常规药物治疗基础上联用BiPAP呼吸机面罩正压通气治疗的26例患者为观察组,比较两组动脉血气分析、血压、心率、呼吸频率的变化.结果:观察组有效率、PaO2、SaO2均明显高于对照组,而呼吸频率较对照组明显降低.P均<0.05.结论:BiPAP呼吸机正压通气治疗急性左心衰竭安全有效,能迅速改善心功能和低氧血症.     

双心室再同步起搏对慢性心力衰竭患者短期疗效观察（附37例分析）

目的：观察心脏再同步化治疗对慢性心力衰竭（CHF）患者的短期临床疗效。方法：对37例CHF患者行双心室再同步起搏治疗前和起搏后6个月的心功能分级（NYHA）,左室射血分数（LVEF）,6min步行试验,心电图QRS波群时限,最大摄氧量（VO2MAX）,生活质量（QOL）作自身对比分析。结果：NYHA,LVEF均有明显改善;QRS时限缩短;6min步行距离由298.48±80.60m上升至375.31±82.51m,提高了25%;VO2MAX绝对值（L.min^-1）由768.18±325.24升至918.39±443.87,VO2MAX相对值（L.min^-1.kg^-1）由12.95±3.95提高至15.52±5.67,QOL评分由22.70±16.10降至8.86±9.40,均有显著差异。结论：双心室起搏能够有效地改善具有心室传导延迟、心脏收缩不同步的慢性心力衰竭患者的心功能,提高生活质量,是治疗慢性心力衰竭的有效方法。     

卡托普利治疗慢性心力衰竭168例疗效观察

目的 :观察卡托普利治疗慢性心力衰竭 (心衰 ) 16 8例临床疗效。方法 :采用随机对照临床试验方法 ,入选慢性心衰患者 16 8例 ,随机分成两组 ,即治疗组 84例 ,男 5 0例 ,女 34例 ,年龄 34～ 82岁 ,口服卡托普利及利尿剂 ,β受体阻滞剂 ,洋地黄类强心剂等治疗 ;对照组 84例 ,男 4 8例 ,女 36例 ,年龄 36～ 83岁 ,不用卡托普利 ,其它治疗同治疗组。结果 :随访半年治疗组患者病死率、再入院率明显低于对照组 (P <0 .0 5 ,0 .0 1) ;主观症状改善、左室射血分数提高 (P <0 .0 5 ) ;心功能分级明显高于对照组 (P <0 .0 5 ) ;两组住院天数无统计学差异。结论 :口服卡托普利有利于控制慢性心衰患者症状 ,改善心功能 ,提高患者生活质量。     

Congestive Heart Failure Patients with Chest Pain: Incidence and Predictors of Acute Coronary Syndrome

OBJECTIVE: New diagnostic and treatment options for emergency department (ED) patients with congestive heart failure (CHF) may facilitate the ED discharge of some patients. However, some patients require admission to exclude concurrent acute coronary syndrome (ACS) as the precipitant of CHF. The objective of this study was to identify the incidence, clinical characteristics, and hospital course of CHF patients who present to the ED with and without concurrent ACS. METHODS: This was a prospective cohort study of consecutive patients >23 years of age who presented to the ED with chest pain, received an electrocardiogram (ECG), and either had a known history of CHF or presented with new-onset CHF, between July 1999 and April 2001. The hospital course of each patient was followed daily, and telephone follow-up occurred at 30 days. The main outcomes were the incidence of ACS and comparisons of lengths of hospital stay (LOSs), rates of admission to the intensive care unit (ICU), intubations, and death rates among patients with and without ACS. RESULTS: Two hundred ninety-eight CHF patients presented 380 times. The incidence of ACS in the 380 patient visits was 32% (95% CI = 27% to 36%). Compared with patients who did not have ACS, patients who had concurrent ACS were more likely to have known coronary artery disease (CAD) (67% vs. 42%; p < 0.0001) and hypercholesterolemia (36% vs. 18%; p = 0.0002). Patients with concurrent ACS were also more likely to be admitted to the hospital (97% vs 82%; p < 0.0001), had a longer LOS (5.2 [3.9-6.5] vs 3.2 [2.6-3.8] days; p = 0.006), had higher rates of ICU admission (44% vs. 13%; p < 0.0001), were more likely to be intubated (8% vs. 1%, p = 0.002), and were more likely to die (15 vs 7 deaths; p < 0.0001). CONCLUSIONS: The incidence of ACS in ED CHF patients with chest pain was 32%. Patients with CHF complicated by ACS had more prolonged hospital stays, required higher levels of care, and had a higher incidence of death than those patients without ACS. Strategies tailored to early identification and management of these patients would be desirable.     

BiPAP呼吸机和硝普钠联合应用治疗高血压急性左心衰临床观察

目的:探讨在硝普钠治疗基础上无创双水平气道正压通气(BiPAP呼吸机)抢救高血压突发急性左心衰的临床效果。方法:将52例在急诊及内科住院期间发生急性左心衰的高血压患者分成两组,对照组30例予硝普钠治疗,治疗组22例在此基础上加用BiPAP呼吸机正压通气治疗,记录两组患者治疗前后心率、脉搏、呼吸、血压、血氧饱和度(SPO2)及临床表现变化情况。结果:治疗组主要临床症状及体征消失或改善快,治疗后血压、心率、呼吸和手指血氧饱和度(SaO2)均有显著改善(P<0.01)。结论:BiPAP呼吸机和硝普钠联合应用治疗高血压急性左心衰疗效肯定。     

冻干重组人脑利钠肽治疗急性心力衰竭32例临床分析

目的:观察冻干重组人脑利尿钠肽(rhBNP)治疗急性心力衰竭的疗效.方法:将2009年8月至2011年5月收治的急性心力衰竭患者63例随机分为观察组(n=32)和对照组(n=31),分别在常规治疗的基础上给予rhBNP和硝普钠治疗,比较两组临床疗效和血浆脑利尿钠肽(BNP)浓度.结果:观察组治疗后的各项指标均较对照组明显好转(P均<0.05).结论:冻干重组人脑利尿肽治疗急性心力衰竭疗效明确,不良反应发生率低.     

急性心肌梗死并发泵衰竭的危险因素分析

目的:探讨急性心肌梗死(AMI)患者并发泵衰竭的危险因素。方法:对96例泵衰竭与139例不伴泵衰竭的AMI患者的临床资料进行对比分析,采用单因素与多因素Logistic回归分析筛选AMI并发泵衰竭的危险因素。结果:心肌梗死病史与心肌多部位梗死是AMI并发泵衰竭的独立危险因素(OR分别为2.318、2.968),而成功溶栓及早期介入治疗则是保护因素(OR分别为0.067、0.163)。结论:对有心肌梗死病史或多部位梗死的AMI患者应提高警惕,密切注意其泵衰竭的发生;早期积极的心肌再灌注治疗可有效预防AMI患者发生泵衰竭。     

急性左心衰竭48例临床分析

目的:总结急性左心衰竭的临床特点及治疗经验,以提高对急性左心衰竭的诊疗水平.方法:回顾性分析2006年1月至2010年12月收治的48例急性左心衰竭患者的临床资料.结果:痊愈36例(75.0%),好转8例(16.7%),死亡4例(8.3%).结论:及时诊断急性左心衰竭和采取综合急救措施可改善预后.     

高血压并发心衰患者85例的临床疗效分析

[目的]观察高血压患者并发心衰的临床特点和疗效,探讨血压与心力衰竭二者之间的相关性.[方法]选取在本院接收治疗的85例高血压并发心衰患者,通过对症治疗,对比分析不同高血压合并心衰患者经对症治疗后血压和左心室射血分数(LVEF)的改变情况.[结果]经过药物治疗,85例高血压合并心衰患者死亡22例,病死率为25.9％;存活患者的血压值与治疗前比较均有所降低(P＜0.05),LVEF较治疗前有所增加(P＜0.05).[结论]对于并发高血压的心衰患者,及时降压治疗既有利于控制心衰患者的病情发展又利于患者的预后,值得临床推广应用.     

急性左心衰竭32例临床分析

目的:总结急性左心衰竭的临床特点和治疗措施,以提高其诊治水平。方法:回顾性分析2011年6月至2013年6月收治的急性左心衰竭患者32例的临床资料。结果:本组32例急性左心衰竭患者中,抢救成功30例(93.8%),死亡2例(6.2%),死于心源性休克和多器官功能衰竭各1例。结论:急性左心衰竭病因复杂,病情危重,早期诊断和针对不同基础心脏病变进行及时有效的救治,可提高其抢救成功率,减少死亡率。     

呼气末正压通气治疗重度急性左心衰竭的临床研究

目的：探讨重度急性左心衰竭或急性肺水肿的机械通气治疗方法。方法：对36例重度急性左心衰竭或急性肺水肿患者行呼气末正压通气（PEEP）治疗前后的临床表现和血气结果进行分析。结果：36例重度急性左心衰竭或急性肺水肿患者经PEEP治疗后，缺氧症状明显好转，血气指标明显改善（P〈0.05）。结论：PEEP是治疗重度急性左心衰竭或急性肺水肿的有效方法。     

小剂量压宁定静脉滴注治疗急性左心衰竭的临床疗效

目的:研究小剂量压宁定与硝酸甘油注射液治疗急性左心衰竭(急性左心衰)的临床疗效。方法:48例急性左心衰患者被随机分为压宁定组(A组)和硝酸甘油组(B组)各24例,治疗前两组年龄、性别、心率、血压等无差异。在常规吸氧、利尿、强心剂使用的基础上,A组予压宁定25 nag加入100 ml液体中以6 mg/小时的速度静脉滴注,B组予硝酸甘油10 mg加入100 ml液体中以1.2 mg/小时的速度静脉滴注,持续12小时,期间不用其它血管扩张剂,持续心电和血压监测,观察用药前后血压、心率、血气分析和心功能的变化。结果:两组治疗后射血分数、每搏出量、主动脉瓣最大血流速度均明显提高,较治疗前均有显着差异(P<0.05),但两组治疗后心率、血压和血气分析改变不明显(P>0.05)。结论:小剂量压宁定静脉应用治疗急性左心衰,可明显改善心脏收缩功能。