应用血管紧张素转换酶抑制剂与β1受体阻滞剂联合治疗慢性充血性心力衰竭26例

慢性充血性心力衰竭是各种心脏疾患常见的终末期临床表现，患者生活质量低下，住院率高，病死率高。2004—2006年我院采取卡托普利、倍他乐克，联合治疗慢性充血性心力衰竭26例，效果显著，不良反应少，现报告如下。     

充血性心力衰竭的药物治疗

充血性心力衰竭(congestive heart failure,CHF)的治疗目的是改善生活质量和延长寿命,其主要的治疗对策有三个部分,即去除基本病因、去除诱发因素和控制心力衰竭状态。由于CHF的主要病理生理改变为神经内分泌激素的过度激活及其导致的血流动力学异常与心室重构,因此治疗的目标应当是限制神经体液过度激活,同时对血流动力学异常所引起的症状进行     

β受体阻滞剂与血管紧张素Ⅱ受体阻滞剂联合治疗慢性心力衰竭的疗效观察

目的观察β受体阻滞剂联合ARB类治疗CHF的临床价值。方法将本院2011年3月至2012年7月收住CHF患者135例随机分为β受体阻滞剂组、ARB组及联合治疗组,三组患者均在给药前进行基础常规治疗。结果联合治疗组临床效果显著优于β受体阻滞剂组及ARB组（P〈0.05）,且联合用药组住院频率、心率等指标好于另两组。结论β受体阻滞剂联合ARB类药物治疗CHF患者能显著降低不良事件的发生率,提高患者生活质量,值得临床推广使用。     

血管紧张素转换酶抑制剂与β-受体阻滞剂联合治疗慢性充血性心力衰竭疗效观察

目的观察血管紧张素转换酶抑制剂(ACET)与β-受体阻滞剂联合治疗慢性充血性心力衰竭(CHF)的疗效.方法将102例CHF患者随机分成2组,在常规治疗的基础上,对照组(A组)采用ACEI制剂卡托普利治疗,治疗组(B组)采用ACEI制剂卡托普利与β-受体阻滞剂美托洛尔治疗,均治疗8～10周.结果A组总有效率为82.35%,B组为96.07%,两组比较有统计学意义(P＜0.05).结论ACEI与β-受体阻滞剂联合治疗CHF比单独使用ACEI疗效更确切.     

氯沙坦治疗慢性充血性心力衰竭86例临床分析

临床研究证实,血管紧张素转换酶抑制剂(ACEI)能显著降低慢性充血性心力衰竭(CH F)的住院率、致残率和病死率,已成为目前治疗CH F的常规药物。对于因使用ACEI出现药疹、血管性水肿、顽固性咳嗽、味觉改变等而不能继续治疗的患者,可改用血管紧张素Ⅱ受体阻滞剂(ARB)治疗。我们于2     

β-受体阻滞剂治疗充血性心力衰竭

有关充血性心力衰竭方面的临床和基础研究是富有成果的。但对这类日趋衰弱、身患致命疾病的患者而言，公认时有效治疗药物仅限于三种:洋地黄、利尿剂和血管扩张剂。其中后者已被证实可提高充血性心力衰竭病人的生存率。近来提出β-受体阻滞剂可能作为一种新的治疗方法。     

β受体阻滞剂治疗充血性心力衰竭

心力衰竭是一种复杂的临床综合症,认为心衰只是由于某种因素造成泵功能低下的理论受到很大挑战,现在认为心衰主要改变是心室结构的改变,心室重塑是心衰的基本特征,也是心衰发病的重要决定因素。由此,心衰的治疗已从短期的药物措施转变为长期的修复性治疗,目的就在于改变衰竭心脏的生物学性质。     

β受体阻滞剂治疗充血性心力衰竭的进展

β受体阻滞剂阻断交感神经过度兴奋，可以有效治疗心衰，是近二十多年来对心衰治疗产生的新认识，也成为心力衰竭现代治疗的新策略。本综述了β受体阻滞剂治疗充血性心力衰竭的进展，包括循证医学研究结果，临床应用应注意的问题等。     

Beneficial effects of the calcium antagonist PN 200-110 in patients with congestive heart failure

We studied the acute hemodynamic effects of PN 200-110, a newly available calcium antagonist, in 12 patients with severe congestive heart failure. Measurements of cardiac performance were obtained by a right heart catheter before and after administration of 5 and 15 mg of PN. Peak drug effects occurred 1-2 h following the administration of PN 200-110 and were dose related. The 15-mg dose reduced mean arterial pressure (MAP) from 90 +/- 11 to 75 +/- 6 mm Hg (mean +/- SD) (p less than 0.001) and decreased systemic vascular resistance (SVR) from 1,740 +/- 500 to 995 +/- 300 dynes X s X cm-5 (p less than 0.01). Stroke volume index (SVI) increased from 26 +/- 7 to 36 +/- 10 ml/m2 (p less than 0.001), and cardiac index (CI) rose from 2.1 +/- .3 to 2.8 +/- .6 L/m2 (p less than 0.01). Pulmonary arterial wedge pressure (PAW) changed insignificantly. Seven patients performed graded supine exercise at identical workloads before and after treatment. When peak exercise values were compared, the addition of PN 200-110 further reduced SVR from 1,282 +/- 461 to 936 +/- 356 dynes X s X cm-5 (p less than 0.01) and increased CI from 3.3 +/- 1.1 to 4.3 +/- 1.3 L/m2 (p less than 0.01). Only minor, self-limiting side effects were noticed during acute administration. Of the seven patients discharged on PN 200-110 and followed for at least 6 months, six reported substantial relief of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Beneficial effects of fenoldopam on systemic and regional hemodynamics in rabbits with congestive heart failure

Fenoldopam (SKF 82526 J) is a selective DA-1 receptor agonist and thus of a potential benefit for promoting afterload reduction, renal vasodilatation, and diuresis in congestive heart failure. To examine the acute effects of fenoldopam in heart failure, studies were performed in control rabbits (n = 6) and in rabbits with chronic congestive heart failure (CHF, n = 6) induced by adriamycin treatment. Cardiovascular variables and regional blood flows were determined before and after an infusion of fenoldopam (150 micrograms/kg total dose). Resting hemodynamics differed in CHF and control groups. In the CHF group, mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) were reduced and right atrial pressure (RAP), left ventricular end-diastolic pressure (LVEDP), and total peripheral resistance (TPR) were increased. Renal blood flow was much reduced in the CHF as compared with the control group (5.1 +/- 0.8 vs. 9.1 +/- 0.6 ml/min.g, p less than 0.05). Similar falls in MAP were noted after fenoldopam in CHF (-13 +/- 2%) and control rabbits (-12 +/- 3%) due to falls in TPR. An increase in CO was observed in both groups, the rise being more pronounced in the CHF group (22 vs. 12%). Heart rate was unchanged by fenoldopam in CHF rabbits but increased in controls. After fenoldopam, CHF rabbits exhibited significantly greater increases in blood flow to each of the three vascular beds studied: renal (113 +/- 27% vs. 7 +/- 13%), mesenteric (249 +/- 60% vs. 15 +/- 19%) and cerebral (145 +/- 13% vs. 12 +/- 12%). Plasma renin and norepinephrine (NE) levels increased after fenoldopam in both control and CHF rabbits. These results show that acute administration of fenoldopam produces favourable systemic and regional hemodynamic responses in rabbits with low output heart failure. However, long-term benefit remains to be demonstrated, particularly considering the hormonal responses.     

坎地沙坦联合卡维地洛治疗充血性心力衰竭疗效观察

目的观察并探讨坎地沙坦联合卡维地洛治疗充血性心力衰竭的临床效果。方法选取本院2010年1月～2012年2月收治的充血性心力衰竭患者120例,采用随机数字表法分为两组,其中对照组60例,在常规抗心力衰竭治疗基础上,加用卡维地洛口服治疗,首次剂量为3mg/d,如效果不理想可逐渐加量至10～12mg/d;联合治疗组60例,在对照组治疗基础上,加用坎地沙坦口服治疗,4mg/d;疗程均为2个月;比较两组患者临床治疗总有效率,治疗前后舒张压、收缩压水平,心率、6min步行实验以及左室射血分数(LVEF)、左室舒张末内经(LVEDD)、左室收缩末期内径(LVESD)等超声心动图指标。结果联合治疗组患者治疗总有效率明显高于对照组,组间比较差异有统计学意义(P<0.05);联合治疗组患者舒张压、收缩压、心率及6min步行实验、LVEF、LVEDD、LVESD等超声心动图指标改善程度均明显优于对照组患者,组间比较差异有统计学意义(P<0.05)。结论坎地沙坦联合卡维地洛治疗充血性心力衰竭能够有效缓解临床症状,改善心功能,具有显著的临床治疗效果。     

Vasodilator therapy in chronic congestive heart failure

Vasodilator agents are relatively new additions to the armamentarium for the management of patients with congestive heart failure. Myocardial failure, irrespective of the aetiology, tends to create a vicious cycle characterised by reduced cardiac output and elevated systemic vascular resistance, which further decrease cardiac output by increasing left ventricular ejection impedance. The rationale for the use of vasodilators is to interrupt the vicious cycle by decreasing the left ventricular ejection impedance by peripheral vasodilatation. Although most vasodilator agents produce qualitatively similar haemodynamic responses, quantitatively their haemodynamic effects differ considerably. Knowledge of the haemodynamic effects of the various vasodilators helps in the selection of a particular drug for the management of such patients. This article reviews the mechanisms of action, haemodynamic effects, pharmacokinetics, clinical usage and adverse effects of non-parenteral vasodilator agents currently available for the management of patients with chronic heart failure.     

Hemodynamic effects of prolonged intravenous therapy with enoximone in patients with severe congestive heart failure

The hemodynamic differences between bolus administration and constant intravenous infusion over a 48-h period with enoximone, a new positive inotropic/vasodilator agent, were evaluated. Twenty-four patients were studied, 15 patients in the bolus group (Group A) and nine patients in the constant infusion group (Group B). The overall hemodynamic results were similar in both groups. Cardiac output increased in Group A from 3.1 +/- 0.71 to 5.5 +/- 1.3 L/min and in Group B from 3.6 +/- 1.0 to 5.9 +/- 1.2 L/min. Significant decreases occurred in pulmonary capillary wedge pressure (30 +/- 7 to 20 +/- 8 mm Hg and 37 +/- 5 to 21 +/- 11 mm Hg) and systemic vascular resistance (2184 +/- 456 to 1300 +/- 305 dyn.s.cm-5 and 1752 +/- 415 to 1035 +/- 130 dyn.s.cm-5). Group A required repeat drug boluses every 3-5 h to maintain these hemodynamic effects. The terminal blood half-life of enoximone derived following the continuous infusion in Group B was 10.6 +/- 7.0 h. In conclusion, intravenous enoximone produces acute salutary hemodynamic effects in patients with severe congestive heart failure that can be sustained for at least 48 h by intermittent boluses or a continuous infusion.     

Intravenous vasodilator therapy in congestive heart failure

The prevalence of congestive heart failure (CHF) is increasing in the US and worldwide, partly because patients are living longer. Treatment of CHF is mostly on an outpatient basis, but inpatient care is required for decompensated CHF, acute CHF or poor response to outpatient treatment. Control of symptoms is usually achieved by diuresis. Intravenous (IV) vasodilators are an important adjunct to the inpatient treatment of CHF. They work mainly by reducing the afterload on the myocardium although preload reduction also occurs. After clinical stabilisation, the goal is to switch to a maintenance oral regimen to be continued as outpatient therapy. The range of IV vasodilators available for inpatient treatment of CHF includes nitrates, phosphodiesterase inhibitors, dobutamine, morphine, ACE inhibitors, B-type natriuretic peptides and endothelin receptor antagonists. As each agent may have a different mechanism or site of action, each agent may affect preload, contractility or afterload to a different extent and it may be desirable to choose one over the other in a particular clinical setting. Examples of standard therapy include dobutamine, milrinone and nitroglycerin. Nesiritide, a B-type natriuretic peptide, is a newer vasodilator and US FDA approved for use in acute CHF. However, most studies with this agent have been in small numbers of patients with anecdotal findings. Larger studies are warranted to pinpoint the efficacy and adverse effects of this agent. It is primarily used to reduce the acuity of decompensated CHF on admission to hospital.Endothelin receptor antagonists show promise in the management of acute CHF, but continue to be investigational. Long-term data on their efficacy and safety are limited. None of the endothelin receptor antagonists are FDA approved for use in patients with CHF.     

大剂量卡托普利联合厄贝沙坦治疗慢性充血性心力衰竭的疗效观察

目的 观察大剂量卡托普利(开搏通)联合厄贝沙坦治疗慢性充血性心力衰竭的临床疗效.方法 慢性充血性心力衰竭患者139例随机分为单独大剂量开搏通治疗组(n=61)和在厄贝沙坦片150 mg/d基础上逐渐加量开搏通片至最大耐受量组(n=78).观察8个月后两组在心胸比、左室舒张末期内径、左室收缩末期内径、左室射血分数(LVEF)、6 min步行实验、住院次数、病死率等项目的 差异.结果 8个月后联用厄贝沙坦组住院次数显著减少(P＜0.01);6 min步行距离、左室舒张末和收缩末内径、LVEF等方面与单独开搏通组差异有统计学意义(P＜0.05);在心胸比、病死率方面无明显差异.结论 卡托普利联合厄贝沙坦较单独卡托普利治疗慢性充血性心力衰竭有更优越的临床疗效,值得临床推广.