二军医大学长征医院心内科.pptVIP

谢谢 * 我申报的题目是 * 图2显示对HF-REF患者使用药物和装置的治疗策略，对每种治疗推荐如下。3大类神经激素拮抗剂——ACEI（或ARB）、β-阻滞剂和盐皮质激素受体拮抗剂——对改变收缩性心衰的病情是至关重要的，至少对每个患者都应考虑。它们常与一种利尿剂联用以缓解充血的症状和体征。下文总结支持本节中推荐的证据，见附表10-13和图2。这些可改变疾病的药物的推荐列于表14。在7.4节中总结了应避免用于HF-REF的药物。  * 图2显示对HF-REF患者使用药物和装置的治疗策略，对每种治疗推荐如下。3大类神经激素拮抗剂——ACEI（或ARB）、β-阻滞剂和盐皮质激素受体拮抗剂——对改变收缩性心衰的病情是至关重要的，至少对每个患者都应考虑。它们常与一种利尿剂联用以缓解充血的症状和体征。下文总结支持本节中推荐的证据，见附表10-13和图2。这些可改变疾病的药物的推荐列于表14。在7.4节中总结了应避免用于HF-REF的药物。  * * The digitalis glycosides exert their effects in patients with HF by virtue of their ability to inhibit sodium-potassium (Na+-K+) adenosine triphosphatase (ATPase). Inhibition of this enzyme in cardiac cells results in an increase in the contractile state of the heart, and for many decades, the benefits of digitalis in HF were ascribed exclusively to this positive inotropic action. However, recent evidence suggests that the benefits of digitalis may be related in part to enzyme inhibition in noncardiac tissues. Inhibition of Na+-K+ ATPase in vagal afferent fibers acts to sensitize cardiac baroreceptors, which in turn reduces sympathetic outflow from the central nervous system. In addition, by inhibiting Na+-K+ ATPase in the kidney, digitalis reduces the renal tubular reabsorption of sodium; the resulting increase in the delivery of sodium to the distal tubules leads to the suppression of renin secretion from the kidneys. These observations have led to the hypothesis that digitalis acts in HF primarily by attenuating the activation of neurohormonal systems and not as a positive inotropic drug. Although a variety of digitalis glycosides have been used in the treatment of HF for the last 200 years, the most commonly used preparation in the United States is digoxin. * * * Patients should not be given digoxin if they have significant sinus or atrioventricular block, unless the block has been addressed with a permanent pacemaker. The drug should be used cautiously in patients taking other drugs that can depress sinus or atrioventricular nodal functio