慢性心衰药物疗新进展---2015、12、26我院心外科会议 定稿.ppt

终上所述，从各大指南在药物治疗的推荐上，我们可以看出，倍阻剂作为心衰患者的基石用药，是大家公认的。里程碑药物：?受体阻滞剂，改善心功能，促使心肌重构延缓或逆转，改善预后。新指南指出所有慢性HF-REF，病情相对稳定，以及结构性心脏病且LVEF≤40%者，均必须且终身使用，除非有禁忌症或不能耐受。 而正确使用BB是新指南的强调内容，1、强调?受体阻滞剂治疗心衰要达到目标剂量或最大可耐受剂量；2、以静息剂量降至55~60/min的剂量为目标剂量。 足量足效！ * * The effect on mortality in these three trials was very similar with a reduction in total mortality of 34%, 34% and 35% in the MERIT-HF, CIBIS II, and COPERNICUS studies, respectively. In addition, the reduction in sudden death also was very similar. A post-hoc analysis on subgroups of patients in NYHA classes III-IV and EF?25% from the CIBIS II and MERIT-HF trials revealed that the baseline characteristics and the outcome were very similar to the COPERNICUS trial. This suggested that the important common property for the three ?-blockers bisoprolol, metoprolol succinate (CR/XL) and carvedilol used in these three studies is the ?1-adrenergic receptor blockade, whereas properties such as ?2-adrenergic and ?-adrenergic receptor blockade do not seem to have any additional effects on mortality and morbidity. Furthermore, there was a strong consistency for the results for gender, etiology of heart failure, heart rate, blood pressure, NYHA class, ejection fraction and concomitant disease like hypertension and diabetes. References Cruickshank JM. Are we misunderstanding beta-blockers. Review. Int J Cardiol 2007;120:10-27 Cruickshank JM. The modern role of Beta-blockers (BBs) in cardiovascular medicine. Shelton, CT: Peoples Medical Publishing House; USA, 2011 MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001–9 CIBIS II Investigators and Committees. The cardiac insufficiency bisoprolol study II (CIBIS II). Lancet 1999;353:9–13 Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001;344(22):1651–58 Waagstein F. Beta-blockers in congestive heart f