卡维地洛的临床应用

心力衰竭在传统的治疗当中 ,β受体阻滞剂由于其负性肌力作用是被禁用的 ,但随着神经内分泌学说的出现 ,β受体阻滞剂在心衰中的治疗作用已引起国内外的重视。卡维地洛是第三代 β受体阻滞剂 ,可非选择性阻滞 β1、β2 和α1受体 ,兼有扩张血管和抗氧化功能 ,可降低心衰死亡危险性 6 5 % ,是第一个被ＦＤＡ批准治疗心衰的 β受体阻滞剂。1　卡维地洛的作用特点卡维地洛是一种具有多种附加作用的第三代 β受体阻滞剂 ,可非选择性阻滞 β1、β2 和α1受体 ,无内源性拟交感活性。通过对α1受体阻滞作用扩张血管 ,降低心脏负荷和血压。阻滞 β受…     

卡维地洛在心血管内科应用的临床评价

卡维地洛 (Ｃａｒｖｉｄｉｌｏｌ)是一种新的非选择性的第三代 β受体阻滞剂 ,兼有选择性阻断α１ 受体 ,且具有明显的抗自由基、抗氧化损伤作用 ,高浓度时还能阻滞钙通道［１］,在调节代谢紊乱、阻止平滑肌细胞增殖等方面具有其他 β 受体阻滞剂无法比拟的优点。卡维地洛可减慢动脉粥样硬化形成的过程。临床上用于治疗高血压病、冠心病及充血性心力衰竭［２］。本文评价卡维地洛在心血管内科的临床应用。一、卡维地洛的药理作用１、肾上腺素能受体阻滞作用卡维地洛是非选择性 β受体阻滞剂 ,对 β１ 和β２ 受体均有阻滞作用。在豚鼠心房 ,…     

卡维地洛治疗心力衰竭的现状

卡维地洛是一种非选择性 β受体阻滞剂 ,可完全阻滞α1、β1和 β2 受体 ,它能显著降低慢性充血性心力衰竭病人的发病率和死亡率 ,本文简要总结了近几年来卡维地洛在心力衰竭中的治疗现状。     

卡维地洛治疗充血性心力衰竭疗效评价

卡维地洛是一种新的非选择性第3代β受体阻滞剂,兼有α1受体阻断作用,且具有明显的抗自由基、抗氧化损伤、阻止平滑肌细胞增殖、抑转左室重构、阻止细胞凋亡等其他β受体阻滞剂无法比拟的优点。本文旨在评价卡维地洛治疗充血性心衰的临床疗效。1对象和方法     

心脏彩超对第三代β—受体阻滞剂治疗心衰的评估

应用第三代 β受体阻滞剂卡维地洛可减轻充血性心力衰竭的症状 ,改善左室功能。应用超声心动图 (ＵＣＧ)评估卡维地洛治疗心衰的疗效 ,以探讨其对心功能、血流动力学的效应。资料与方法1999年 3月～ 11月在我院诊治的 30例充血性心力衰竭患者 ,平均年龄 (5 7.6± 13 .4)岁。纽约心脏协会 (ＮＹＨＡ)分级心功能Ⅱ～Ⅲ级 ,左室射血分数≤ 0 .35 ,无房室传导阻滞 ,无肝肾疾病 ,未应用其他 β阻滞剂、抗心律失常药、钙拮抗剂、抗抑郁药、β激动剂。所有患者都接受心衰的基本治疗 ,有心绞痛或心肌缺血者亦应用硝酸酯类药物治疗。所有患者随机分为…     

卡维地洛对慢性收缩性心衰左室重塑的影响

本文以临床常用的美托洛尔为对照,研究第三代新型β受体阻滞剂卡维地洛对慢性收缩性心衰左室重塑的影响.     

卡维地洛联合多巴酚丁胺治疗充血性心衰的疗效观察

卡维地洛是具有扩血管特性的B受体阻滞剂，主要用于充血性心衰，高血压病以及心绞痛的治疗。多巴酚丁胺是非洋地黄类的正性肌力药物，自20世纪70年代以来已广泛应用于临床治疗各种病因所致的充血性心力衰竭。我科于1993—2004年对39例充血性心衰患者采用卡维地洛联合多巴酚丁胺治疗，疗效令人满意，现报道如下。     

单独或联合应用地高辛与卡维地洛对60例房颤合并心衰的疗效观察

卡维地洛是第三代β-受体阻滞剂，尚有阻滞α1-受体、抗氧化、抑制平滑肌细胞增殖作用。单独应用卡维地洛对房颤合并心衰的疗效尚未可知，本研究旨在比较单用地高辛或卡维地洛及两者联合应用对房颤合并心衰患者疗效的差异。     

卡维地洛改善老年人心功能及二尖瓣返流疗效观察

卡维地洛（商品名洛德）是新的第3代口受体阻滞剂,研究表明,经卡维地洛对心力衰竭的治疗后病死率显著较安慰剂组降低65％,卡维地洛组猝死和泵衰竭呈同样程度的降低。但对慢性心衰并二尖瓣返流可否同时改善,目前尚知之甚少。作者应用卡维地洛对30例老年慢性充血性心力衰竭（CHF）合并二尖瓣返流患者进行治疗,现报告如下。     

卡维地洛治疗轻中度原发性高血压疗效观察

卡维地洛是一种新型、具有特殊药理作用的非选择性β-受体阻滞剂，兼有β-受体和α1-受体阻滞作用，是一种很有前途的新型降压药。本研究中以高选择性α1-受体阻滞剂比索洛尔为对照，观察卡维地洛治疗轻中度原发性高血压的临床疗效及安全性。     

依那普利与卡维地洛联合治疗慢性充血性心力衰竭

目的：评价依那普利与卡维地洛联合应用治疗慢性充血性心力衰竭的疗效和安全性。方法：110例充血性心力衰竭患者随机分为依那普利联合卡维地洛组（68例）、依那普利组（42例）。在心衰标准用药基础上，依那普利、卡维地洛均由小剂量开始，逐渐递增至目标剂量。全部病例在治疗后12个月进行心脏超声检查，以评价治疗前后左室功能和容积。结果：治疗后心功能和6min步行距离较治疗前明显改善（P〈0．01），两组的左室射血分数（LVEF）均有增加，左室收缩末期容积（LVESV）和左室舒张末期容积（LVEDN）均有减少，但依那普利联合卡维地洛组与单独依那普利组比较，差异有显著性，（P〈0．05）。两组均未发生肝、肾功能损害，无血脂、电解质和血糖变化。结论：依那普利与卡维地洛联合治疗轻中度慢性充血性心力衰竭安全、有效。     

卡维地洛在充血性心力衰竭治疗中的应用

目的研究新型β-受体阻滞剂国产卡维地洛(Carvedilol)对充血性心力衰竭患者心功能及神经内分泌激素的影响。方法40例住院慢性充血性心力衰竭患者,双盲随机分为安慰剂组及治疗组。治疗组在常规治疗基础上加服卡维地洛,安慰剂组在常规治疗基础上加服用等量安慰剂片。观察心率、血压、6 min步行距离、心功能级别、超声心动图测量左室射血分数(LVEF)、左室内径(LVDd),血浆去甲肾上腺素(NE)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)及血生化指标,并分别于治疗后1个月,3个月复查。结果心力衰竭患者血浆中NE、PRA、AngⅡ水平均较正常安慰剂组明显升高(P<0.01),且心衰越重,升高越明显。治疗组经治疗后血浆NE、PRA、AngⅡ水平均较治疗前明显下降(P<0.01),且心衰恶化发生率亦明显低于安慰剂组,严重心脏事件发生率亦较安慰剂组降低了76%(P=0.028),6 min步行距离、心功能级别均有明显改善,LVEF明显提高,LVDd缩小。结论卡维地洛能降低心衰患者血循环去甲肾上腺素、肾素及血管紧张素水平,改善慢性充血性心力衰竭患者的生活质量,改善心功能。     

Hypotension with dobutamine: beta-adrenergic antagonist selectivity at low doses of carvedilol

OBJECTIVE: To report a case of marked hypotension resulting from the concomitant use of low-dose carvedilol and intravenous dobutamine. CASE SUMMARY: A 54-year-old white man with severe heart failure was placed on carvedilol 3.125 mg orally twice a day; three days later the dosage was increased to 6.25 mg orally twice a day. His symptoms of heart failure worsened with increasing fluid retention, orthopnea, paroxysmal nocturnal dyspnea, and elevated blood urea nitrogen and creatinine. He was admitted for treatment of decompensated heart failure with intravenous dobutamine. With each increase in intravenous dobutamine, systolic blood pressure fell. Dobutamine was discontinued when systolic blood pressure reached 56 mm Hg. In a subsequent admission for decompensated heart failure, when the patient was not taking carvedilol, he was treated with intravenous dobutamine and systolic blood pressure increased. DISCUSSION: Although carvedilol is a nonselective beta-adrenergic antagonist, at low doses it is a selective beta1-adrenergic antagonist. Dobutamine is a beta1-, beta2-, and alpha1-adrenergic agonist. Typically, patients with heart failure treated with intravenous dobutamine have a small increase in systolic blood pressure. We propose that the drop in blood pressure with dobutamine in this patient was caused by a fall in systemic vascular resistance due to vascular beta2-adrenergic receptor activation. The normal increase in cardiac output was partially blocked by selective beta1-adrenergic blockade at low doses of carvedilol. CONCLUSIONS: Beta-adrenergic blockade with carvedilol is now common therapy for patients with congestive heart failure. Intravenous dobutamine is often used when these patients have worsening heart failure. Recognition that treatment with dobutamine in patients taking low doses of carvedilol may result in hypotension is important for appropriate monitoring and therapy.     

Carvedilol: use in chronic heart failure

Carvedilol is a beta-adrenergic antagonist with vasodilatory properties (alpha1-antagonism), which has been extensively evaluated in the treatment of patients with heart failure. In patients with chronic heart failure carvedilol improves left-ventricular (LV) ejection fraction over 6 to 12 months of treatment, and attenuates LV remodelling. Large-scale randomised, placebo controlled trials involving more than 4000 patients with chronic heart failure have demonstrated that carvedilol improves survival and reduces hospitalizations. Comparative studies with metoprolol in patients with heart failure have suggested that carvedilol may be associated with greater survival benefit although differences in the preparation of metoprolol have left uncertainty in this area. Carvedilol has a high safety profile and the clinical benefits appear maintained across a wide range of patients with comorbidities such as diabetes and renal failure. Carvedilol has also been shown to attenuate LV remodeling and improve clinical outcomes in patients with LV dysfunction and/or heart failure following acute myocardial infarction. As a result of these data, carvedilol is recommended for treatment of patients with heart failure in heart-failure guidelines. This evidence-based treatment should be widely implemented to ensure that patients with heart failure receive appropriate medical therapy.     

Augmented Digoxin Concentrations with Carvedilol Dosing in Mild-Moderate Heart Failure

Carvedilol is a partially selective beta-adrenergic blocking agent. Recent clinical studies have suggested that carvedilol may improve left ventricular function and symptoms in patients with heart failure. The effects of carvedilol on serum digoxin levels in subjects with heart failure is unknown. Therefore, 22 New York Heart Association functional class II--III patients with idiopathic dilated cardiomyopathy were studied in a prospective, double-blind, placebo-controlled trial. The patients were selected from a clinical trial evaluating the efficacy and hemodynamic effects of chronic carvedilol treatment in heart failure. Carvedilol administration was associated with a 26% increase in steady-state serum digoxin concentrations versus placebo (p = NS). No patients required digoxin dosage adjustments and there were no clinically significant adverse events directly attributable to an increase of serum digoxin concentration. Thus, clinical significant changes in serum digoxin concentrations are not observed in most patients who receive carvedilol. However, the small increase in serum digoxin concentrations warrants caution be exercised in patients with elevated digoxin concentrations during coadministration of carvedilol.     

Clinical Pharmacology of Carvedilol

BACKGROUND: There is now a wealth of data supporting the use of beta-blockers in heart failure and the additional pharmacological properties of carvedilol are thought to play an important role in the therapeutic efficacy of carvedilol in this disease. METHODS AND RESULTS: Carvedilol is licensed for the treatment of essential hypertension, chronic stable angina, and mild to moderate chronic heart failure. This article provides an up-to-date review of the clinical pharmacology of carvedilol, with particular emphasis on its clinical effects in heart failure. CONCLUSION: Carvedilol is a multiple-action neurohormonal antagonist that offers nonselective beta-blockade, alpha-1 blockade, antioxidant, anti-ischemic mortality, and anti-proliferative properties. In addition to reductions in hospitalization and mortality rates, benefits of carvedilol in heart failure include dramatic improvements in left ventricular function and other parameters of cardiac remodeling.     

Heart failure in a district general hospital: are target doses of beta-blockers realistic?

BACKGROUND: Carvedilol therapy reduces mortality in patients with chronic heart failure. Multi-centre studies suggest a low first dose failure rate and high levels of tolerability to carvedilol. Little is known, however, concerning the eligibility and tolerance to treatment with carvedilol within a district general hospital setting. Aim: To evaluate the eligibility and tolerance of patients with heart failure to carvedilol within a district general hospital. DESIGN: Prospective clinical audit analysis. METHODS: We assessed 100 heart failure patients eligibility to commence carvedilol therapy. In those who satisfied clinical criteria, we evaluated first dose failure rate, target dose achievement, reasons for intolerance, heart rate and blood pressure reduction and resource requirements over a six-month period. RESULTS: Of 100 patients, 16% had contra-indications to commence carvedilol and 22% were receiving a beta-blocker as part of their existing heart failure therapy. Although 62% satisfied eligibility criteria, 1% refused therapy, thus 61% were initiated on carvedilol. The first dose failure rate was 11.5% and 6.6% of patients achieved 'target dose'. Mean heart rate and systolic blood pressure reductions were 15 (SE 1.2)bpm and 17 (SE 1.7) mmHg, respectively. Resource requirements included 155 hours of work-time for a trained heart failure specialist nurse and doctor. CONCLUSIONS: In the general setting, eligible patients appear to display a high first dose failure rate, poor tolerance to higher doses and achievement of a 'target dose' of carvedilol. Responses to adrenergic blockade were similar to previously published data, irrespective of the final tolerated dose, suggesting that the concept of achieving a 'target dose' may not be clinically useful. Guidelines and treatment protocols for heart failure should reflect not only what is considered gold standard, but also what is practical in general hospitals.     

卡维地洛对扩张型心肌病心力衰竭患者心功能及运动耐量的改善作用

Thispaperaimstostudytheeffectofcarvedilolonthecardiacfunction，andexercisetoleranceinpatientswithheartfailure（HF）ofDCM．１Subjectsandmethods１．１Subjects６０casesofpatientsconsistentwiththediagnosticcriteriaofWHO／ISFC，１９９５，withcardiacfunctionofgradeII～III，wererandomlydividedintocarvediloltreatedgroup（thetestgroup）andthecontrolgroupwith３０patientsineach．Thetestgroupwascomposedof１７malesand１３females，aging３４～７４years，meanly（５６．０±１０．０）years，withcardiacfu…     

心力衰竭并发肺动脉栓塞研究进展

充血性心力衰竭（CHF）在许多临床表现上与肺动脉栓塞相似,而前者易并发后者,两者一旦合并存在,即提示患者预后更为恶劣。该文从发病原因、危险因素、临床表现、诊断与预后、预防及治疗等方面复习近年心力衰竭并发肺动脉栓塞研究进展,以期能在诊断及预防CHF并发肺动脉栓塞等方面提供相关的信息和思路。     

卡维地洛对充血性心力衰竭患者QT离散度的影响

目的　探讨充血性心力衰竭 (CHF)患者 QT间期离散度 (QTd)的变化及卡维地洛对其影响。方法　选择CHF患者 80例和 30例健康人作 QTd测量 ,80例 CHF患者随机分为卡维地洛治疗组 (32例 )和常规治疗组 (48例 ) ,比较 2组治疗前后 QTd的变化。结果　 CHF患者的 QTd明显高于健康人 (P<0 .0 1) ;卡维地洛组治疗后 CHF患者的QTd明显缩短 (P<0 .0 1) ;CHF伴有严重室性心律失常者与不伴有者相比 ,QTd明显延长 (P<0 .0 1)。结论　 QTd在CHF患者明显延长 ,且能预测恶性心律失常的发生。卡维地洛能缩短 CHF患者 QTd。