(精选)【医学课件课件】ACEI vs ARB 在冠心病治疗中的应用教学课件.pptVIP

总 结 ACEI在冠心病的治疗中地位坚实，证据确凿，而ARB仅作为ACEI不能耐受时的替代 联合ACEI是冠心病患者降压治疗的优选降压方案 福辛普利（蒙诺?）是ACEI的优选 心血管保护证据可靠的ACEI 肝肾双通道代偿排泄，肾功能不全患者无需调整剂量 24小时平稳降压，真正一天一次的ACEI ????????????????????????? Thank You * Five major morbidity and mortality statin studies in primary or secondary prevention populations have been completed. This pyramid ranks the studies according to the type of patients that were included in each study. It begins with AFCAPS/TexCAPS, a primary prevention study in patients at low risk of CHD and moves to a smaller group of high-risk CHD patients in 4S, a secondary prevention study. In between the two extremes, covering the majority of patients with and at risk of CHD, are WOS, CARE, and LIPID. The Cholesterol and Recurrent Events (CARE) and Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) studies are representative of the majority of patients with CHD, because patients in these trials had cholesterol levels that were, in general, considered to be in the average range (similar to those of the general population) rather than elevated.  * 那么，让我们来简单分析一下ACEI治疗心梗后患者的循证医学证据。 目前已经有超过10万例的临床试验证实了ACEI对心肌梗死后患者的治疗益处。 现有研究可分为两类，一类包括CONSENSUS II、GISSI-3、ISIS-4和Chinese-Cap，这些研究是在心梗后早期使用ACEI治疗，可以观察到其显著的降低死亡率的益处。 另一类则是针对高危心梗后患者进行长期治疗的研究，研究对象为合并左室功能不全和/或急性心衰的临床表现的患者。研究包括SAVE、AIRE、SMILE和TRACE。使用ACEI后对这一类患者的治疗利益更加突出。 【参考文献】 Swedberg, et al., CONSENSUS II, NEJM:327:678-684,1992. GISSI 3 investigators, LANCET, 343: 1115-22, 1994. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group,Lancet; 345:669-85,1995 Chinese Cardiac Study Collaborative Group,Lancet; 345:686-7,1995 Kober L, Torp-Pedersen C, Carlsen JE, et al for the Trandolapril Cardiac Evaluation (TRACE) Study Group N Engl J Med; 333:1670-6,1995. Pfeffer MA, Braunwald E, Moye LA, et al on behalf of the SAVE Investigators. N Engl J Med; 327:669-77,1992. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators.Lancet; 342:821-8, 1993. Ambrosioni, SMILE investigators, NEJM: