人工心脏植入后药物治疗.ppt

Drug Management of INCOR Patients Anticoagulation Platelet Inhibition Heart Failure Therapy Additional Drugs OR / ICU Management Anticoagulation / Platelet Inhibition Intraoperatively: Heparin for extracorporeal circulation, Aprotinin, reversal of Heparin First 6 hours postoperatively : no anticoagulant drugs 6 hours postoperatively and no bleeding: Heparin depending on aPTT(70-80s) When drains are removed: anti-aggregation (Aspirin, Clopidrogel) and anti-adhesive drug (Dipyridamole)Switch from Heparin to Coumadin: INR 2,5 – 3 – 3,5 Anticoagulation Monitoring Coumadin: INR 2,5 – 3 –3,5 Heparin: PTT - 70 s Aspirin: Platelet Aggregation Test (Arachidonic Acid) Clopidrogel: Platelet Aggregation Test (ADP) Overall: Thrombelastography Heart Failure Therapy Beta-Blocker (Carvedilol) ACE-Inhibitor or ARB (Angiotensin II receptor Antagonist) Spironolactone Your Aim: MAP 70 mmHg --- HR 70 bpm Remember: Flow of axial pump depends on afterload Additional Therapy Antioxidants Reduce oxidative Stress Phospholipids Membrane Stabilization OR / ICU - Management OR Nitric Oxide Transesophageal Echo ICU Inotropic Support for RV (epinephrine) Keep MAD low ! Enough volume to prevent suction * Beta-Blocker reduce total mortality reduce sudden death reduce hospitalization improve the functional class ACE_Inhibitors First-line therapy in patients with all stages of heart failure together with Beta-Blocker improves suvival and reduces the rate of hospitalization has been evaluated in more than 7000 patients in prospective, placebo-controlled clinical trials. Angiotensin-Receptor-Blocker ARBs could be considered in patients who do not tolerate ACE inhibitors. It is unclear whether ARBs are as effective as ACE inhibitors for mortality reduction. In patients who also receive a Beta Blocker a trend towards a negative effect was observed. Aldosterone promotes: Vascular and myocardial fibroses Potassium and magnesium depletion Sympathetic activ