儿科心血管系统-heart failure英文二部分PPT.pptVIP

* * * * * * Management of Heart Failure Treatment Strategies: Ameliorate symptoms Maintain cardiac functional state Reduce mortality rate Reduce hospitalization Treatment 1. The cause must be removed 2. General management: bed rest, mitigate，oxygen inhalation， reduction of salt intake 3. Drug Treatment Drug Treatment Positive inotropic agents—cardiac glycosides, phosphodiesterase inhibitors Vasodilators Diuretics Angiotensin converting enzyme inhibitors (ACEI) Beta-blockers 治疗 洋地黄类药物：正性肌力，负性传导，负性心率；直接抑制过度的神经内分泌系统。 临床常用制剂：地高辛；西地兰。 常用剂量：地高辛口服化量：＜2岁0.05-0.06mg/kg，＞2岁0.03-0.05mg/kg，维持量为化量的1/5。西地兰静注化量：＜2岁0.03-0.04mg/kg，＞2岁0.02-0.03mg/kg。 新生儿用量更少，取婴儿量的1/2至2/3。 治疗---洋地黄类药物 注意事项：用药前了解洋地黄情况；避免用钙剂；注意纠正低血钾。 洋地黄中毒 表现：心律失常；消化道症状；神经系统症状等。 处理：停用洋地黄及利尿剂；口服补钾；必要时用抗心律失常药。 Diuretics Relieve the congestion status by elimination of sodium and water. Indicated in pulmonary congestion with dyspnea and rales and generalized edema ,ascites Agents used: Thiazides—chlorothiazide , chlothalidone Loop diuretics—furosimide, bumetanide, ethacrynic acid Potassium-sparing diuretics—spirolectone, triamterene, amiloride Side effects: hypokalemia, hyperglycemia ACE-Inhibitors Rationales of the ACEI treatment for heart failure: Decreases peripheral circulatory resistance Decreases the blood volume Decreases the sympathetic activity Inhibition of the remodeling process ACE-Inhibitors Short-term effects Symptomatic improvement: approximately 2/3 of cases with severe heart failure show diurea, improvement in dyspnea and less edema. Hemodynamic improvement: increased cardiac output by 25%-30% reduction of PCWP by 20% decreased peripheral resistance by 30% BP—drop 10%-15% Heart rate—slightly reducsed N.B. 1st dose hypotension, transient elevation of BUN and creatinin ACEI treatment of H.F. Long-term effects : Reduction of mortality and preservation of cardiac function. SAVE study: Cases: post acute myocardial infarction with EF40%