心力衰竭药物治疗新证据与新视野.pptVIP

心力衰竭药物治疗

新证据与新视野李勇复旦大学附属华山医院心脏科上海200040

治疗心力衰竭的药物1、强心苷类药物2、利尿剂3、ACE抑制剂及血管紧张素II（AT1）受体拮抗剂4、?受体阻断剂5、其他治疗CHF的药物：（1）钙拮抗剂（2）磷酸二酯酶抑制剂（3）其他血管扩张剂：长效硝酸酯类，肼苯哒嗪

DIG研究50403020100Placebon=3403Digoxinn=3397480122436Mortality%NEnglJMed1997;336:525Monthsp=0.8DigitalisN=6800NYHAII-III

0.6ProbabilityofDeath0Placebo(273)

Prazosin(183)

Hz+ISDN(186)Months0.70.50.30.40.20.1NEnglJMed1986;314:1547Nitrates06121824303642V-HeFT-I研究combinationofhydralazine(300mg/day)andisosorbidedinitrate(160mg/day23%reductioninmortality

PlaceboEnalapril12111098765ProbabiilityofDeathMonths0.10.800.20.30.70.40.50.6p0.001p0.002NEnglJMed1987;316:142943210CONSENSUS研究253patientswithclassIVheartfailureEnalapril：2.5-40mg/day31%reductioninmortality

50403020100Months0612p=0.0036%Mortality241830364248Enalapriln=1285Placebon=1284

NEnglJM1991;325:293n=2589CHF-NYHAII-III-EF35SOLVD(Treatment)研究11.3%reductioninmortality

0,540,480122448600.750.500.2500.470.360.250.130.090.310.180.4236Monthsp=0.08NEnglJMed1991;325:303EnalaprilHZ+ISDNn=804p=0.016ProbabilityofdeathNitrate+HydralazineVsEnalaprilV-HeFTII研究

卡维地洛n=696安慰剂n=398存活天050100150200250300350400危险度下降=65%p0.001Packeretal(1996)CIBIS-IIInvestigators(1999)比索洛尔安慰剂接收后的时间(天)p0.0001存活危险度下降=34%TheMERIT-HFStudyGroup(1999)美国卡维地洛计划CIBIS-II0.81.00.60随访月03691215182120151050安慰剂美托洛尔CRp=0.0062危险度下降=34%MERIT-HF月003691215182110090806070卡维地洛安慰剂危险度下降=35%存活Packeretal(2001)哥白尼（COPERNICUS）研究p=0.000130.50.60.70.80.91.00200400600800死亡率(%)

AldactonePlaceboSurvival1.00.90.80.70.60.5061218243036monthsp0.0001AnnualMortalityAldactone18%;Placebo23%RR－21.7%N=1663NYHAIII-IVMeanfollow-up2yNEJM1999;341:709SpironolactoneRALES研究

心力衰竭药物治疗Asymptomatic Mildtomoderate ModerateLVdysfunction CHF tosevereCHFACEinhibitor Digoxin DigoxinBetablocker Diuretics Diuretics ACEinhibitor ACEinhibitor Betablocker Betablocker Spironolactone

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