β受体阻滞剂与抗心律失常作用演示幻灯片.pptVIP

祝大会圆满成功！ 谢谢大家！ 作用机制 B阻滞剂预防心血管疾病和保护和保护心血管的作用机制可能是多方面的 提起抗诉拮抗儿茶酚胺的心脏毒性毒性为其主作用。与儿茶酚胺竞竞争性结合B受体，产生负性肌力、负性频率和负性传导作用 其他作用机制包括： 抗高血压作用：伴有心排量减少，抑制肾素释放和血管紧张素II生成，阻断突触前?肾上腺素能受体和降低中枢血管运动活性. 抗缺血作用：通过降低心率、心脏收缩力和收缩压、降低心肌耗氧量。并且，心率减慢使舒张期延长、有利于增加心肌灌注。 抑制肾素、血管紧张与醛固酮的生成。通过阻断肾小球旁细胞的B1肾上腺素能受体减少肾素释放和减少血管紧张II与醛固酮的生成。 改善左心室的结构和功能，使扩大 的左心室变小和提高左心室射血分数。其改善心功能的机制包括： I减慢心率 II抑制儿茶酚胺诱导的游离脂肪酸从脂肪组织释放，改善心肌能量代谢 III上调B肾上腺素能受体 IV减少心肌氧化负荷 抗心律失常作用 I直接的心电生理作用：减慢心率，抑制异位起搏点的自发放电，减慢传导，延长房室结不应期 II间接的心电生理作用：抑制交感兴奋，减少心肌缺血，改善压力感受器预防儿茶酚胺诱导的低血钾 CAST: Ⅰ类抗心律失常药物减少早搏、增加死亡回顾性分析基线时使用?-阻滞剂对死亡率的影响 2611例入选患者（心肌梗死后/LVEF?40%） ?-阻滞剂组: 718例 非?-阻滞剂组: 1893例 结果: ?-阻滞剂组30天、1年、2年心律失常死亡/非致死心脏骤停（主要终点）和总死亡率均显著降低 ?-阻滞剂能二级预防、并可能有抗致心律失常作用 Beta-blocker therapy in the Cardiac Arrhythmia Suppression Trial. CAST Investigators. Kennedy HL, Brooks MM, Barker AH, Bergstrand R, Huther ML, Beanlands DS, Bigger JT, Goldstein S. Cardiovascular Research Foundation, St. Anthonys Medical Center, St. Louis, Missouri. The Cardiac Arrhythmia Suppression Trial (CAST) showed antiarrhythmic drug suppression of asymptomatic or mildly symptomatic ventricular arrhythmias in survivors of myocardial infarction to be harmful. This study retrospectively searched the CAST results for evidence of mortality and morbidity reduction in patients receiving optional beta-blocker therapy. All enrolled (n = 2,611) and suppressed main study (n = 1,735) CAST patients with an ejection fraction of or = 40% were examined using univariate analysis, Kaplan-Meier curves, and a Cox proportional-hazards multivariate analysis with respect to optional beta-blocker therapy prescribed at baseline. CAST patients receiving beta-blocker therapy had significantly enhanced survival at 30 days, and at 1 and 2 years of follow-up against all-cause and arrhythmic death or nonfatal cardiac arrest. Multivariate analysis showed beta-blocker therapy to be independently associated with a one-third reduction in arrhythmic death or cardiac arrest (p = 0.036). In CAST patients wit