心律失常药物治疗现状—培训课件.ppt

新的抗心律失常药 缝隙连接增强剂：罗替伐汀（Rotigaptide）是多巴胺D2受体激动剂，可改善细胞间的偶联，选择性改变心房电生理特性，降低房颤的易损期，目前还在实验室阶段 5-羟色胺受体拮抗剂：5-羟色胺4型受体仅存在于心房，刺激后可产生正性速率作用而诱发心律失常，其拮抗剂RS-100302在动物实验中可终止房颤并预防诱发，但至今尚无临床研究 心律失常的治疗现状 药物在器质性心脏病中 ——Ⅰ类抗心律失常药物的应用正日趋减少 ——β-阻滞剂已成为治疗的基石 ——Ⅲ类抗心律失常药物胺碘酮孤军奋战 ——新的抗心律失常药很有希望 心律失常的非药物治疗飞速发展，必将成为治疗的重要方法，但药物治疗仍然是治疗的主要方法 改善患者的远期预后成为最关注的问题 心律失常的相关情况（如血栓栓塞）成为预防治疗的主要内容 谢谢！ * * * 10 * 11 * There are many targets for novel anticoagulants in the coagulation pathway: Tissue factor pathway inhibitor (TFPI) bound to Factor Xa inactivates the tissue factor (TF)–Factor VIIa complex, preventing initiation of coagulation Activated protein C (APC) degrades Factors Va and VIIIa, and thrombomodulin (soluble; sTM) converts thrombin (Factor IIa) from a procoagulant to a potent activator of protein C Fondaparinux and idraparinux indirectly inhibit Factor Xa, requiring antithrombin (AT) as a cofactor Direct (AT-independent) inhibitors of Factor Xa include rivaroxaban (BAY?59-7939), LY517717, YM150 and DU-176b (all orally available), and DX-9065a (intravenous) Oral, direct thrombin inhibitors include ximelagatran (now withdrawn) and dabigatran Weitz JI Bates SM. New anticoagulants. J Thromb Haemost 2005;3:1843–1853 * * This slide shows the KM curves in the strict and lenient group over 3 years of follow up. The 2 Kaplan-Meijer curves were superimposible with a slight trend favoring lenient control with a cumulative incidence of the primary outcome of 12.9% for the lenient and 14.9% for the strict group. * * this slide shows the distribution of morbidity and mortality over the various components of the primary endpoint adds up to 16,8% and 20,3% CV mortality was seen in 2.9% and 3.9% in lenient and strict group, respectively. HF occurred in 3.8 and 4.1%, stroke in 1.6 and 3.9%, systemic embolism in 0.3% n the lenient group, and bleeding in 5.3 and 4.5%. Adverse effects of rate control drugs in 1.1% versus 0.7% in the lenient and strict group, pacemakers in 0.8% in the lenie