急性失代偿性心力衰竭的治疗选择(2016南方医科大学南方医院心血管内科).ppt

JAMA. 2013 Dec 18;310(23):2533-43. （三） JAMA. 2013 Dec 18;310(23):2533-43. （三） JAMA. 2013 Dec 18;310(23):2533-43. （三） JAMA. 2013 Dec 18;310(23):2533-43. （三） ROSE-AHF研究结论 对ADHF伴有肾功能不全患者，小剂量多巴胺、小剂量奈西立肽分别与袢利尿剂联合用药未能显著增加患者尿量和改善肾功能。 亚组分析显示（1）小剂量奈西立肽与袢利尿剂联合用药可能增加LVEF50%或收缩压114mmHg的心衰患者的尿量，可能有益；（2）小剂量多巴胺袢利尿剂联合用药可能会减少LVEF50% 的心衰患者的尿量，可能有害。 JAMA. 2013 Dec 18;310(23):2533-43. （三） Published online 06.November, 2012 /10.1016/S0140-6736(12)61855-8 AHA 2012 增加新的治疗靶点 燃起新希望 （四） Pregnancy the Heart Baylis, C. Am J Kid Dis 1999; Schrier, RW, et al. Am J Kid Dis 1987; Jeyebalan, A, et al. Adv Exp Med Biol 2007;Teichman SL et al. Curr Heart Fail Rep 2010;7:75–82. Helal I, et al. Nature Reviews 2012;293-300. Parameter Pregnancy Cardiac Output (L/min) 20% Increase Systemic Vascular Resistance (dyn.s.cm2) 30% Decrease Global Arterial Compliance (mL/mm Hg) 30% Increase Renal Blood Flow (mL/min/1.73m2) 50-85% Increase Creatinine Clearance (mL/min/1.73m2) 40-65% Increase Relaxin has been shown to mediate these changes, as well as to have anti-ischemic, anti-inflammatory, anti-fibrotic effects. Relaxin is elevated through 9 months of pregnancy and mediates physiologic hemodynamic adjustments to growing baby Pharmacologic use of serelaxin may produce these beneficial effects in acute heart failure （四） Inclusion and Exclusion Criteria Key Inclusion Criteria Hospitalized for AHF Dyspnea at rest or with minimal exertion Pulmonary congestion on chest radiograph BNP ≥350 pg/mL or NT-pro-BNP ≥1400 pg/mL Received ≥40 mg IV furosemide (or equivalent) at any time between admission to emergency services (either ambulance or hospital, including the ED) and the start of screening for the study Systolic blood pressure 125 mmHg Impaired renal function on admission (sMDRD eGFR 30-75 mL/min/1·73 m2) Randomised within 16 hours from presentation Age ≥18 years of age Body weight 160 kg Key Exclusion Criteria Current or planned treatment with any IV therapies [i.e. other vasodilators