心力衰竭的药物和器械治疗-.ppt

心力衰竭的药物和器械治疗 名词解释 CRT: 心脏再同步化治疗 ICD: 埋藏式心脏转复除颤器 CRTD： CRT＋ICD SCD-HeFT Sudden Cardiac Death In Heart Failure Trial 1996-2003 2521病人 比较胺碘酮和ICD对严重心衰患者生存情况的影响 心功能II-III EF0.35 无持续室性心动过速病史 SCD-HeFT结论 在II-III级心衰，EF .35，安慰剂组年中死亡率为7.2% ICD治疗降低死亡率23% 胺碘酮治疗不改善死亡率 * Angiotensin converting enzyme inhibitors are the best studied class of agents in HF, with multiple mechanisms of benefit for both HF, coronary disease, and other atherosclerotic vascular disease, as well as diabetic nephropathy. for initiation rather than maintenance of therapy. Which approach should be followed? In the controlled clinical trials of ACEIs, low or intermediate doses were commonly prescribed if higher doses could not be tolerated. In controlled trials with newer agents for HF, intermediate doses rather than high doses of ACEIs were generally used as background therapy. Higher doses of an ACEI were better than low doses in reducing the risk of hospitalization, but they showed similar effects on symptoms and mortality. Clinicians should attempt to use doses that have been shown to reduce the risk of cardiovascular events in clinical trials. If these target doses of an ACEI cannot be used or are poorly tolerated, intermediate doses should be used with the expectation that there are likely to be only small differences in efficacy between low and high doses. More importantly, clinicians should not delay the institution of beta-blockers in patients because of a failure to reach target ACEI doses. Once the drug has been titrated to the appropriate dose, patients can generally be maintained on long-term therapy with an ACEI with little difficulty. Although symptoms may improve in some patients within the first 48 hours of therapy with an ACEI, the clinical responses to these drugs are generally delayed and may require several weeks, months, or more to become apparent. Even if symptoms do not improve, long-term treatment with an ACEI should be maintained to reduce the risk of death or hos