慢性阻塞性肺疾病合并慢性心力衰竭患者使用β阻滞剂探讨.docVIP

慢性阻塞性肺疾病合并慢性心力衰竭患者使用β阻滞剂探讨 　　[摘要] 慢性阻塞性肺疾病（COPD）是呼吸系统常见病，是一组与年龄呈正相关的全身炎症性疾病；慢性心力衰竭（CHF）多系高血压、冠心病发展到一定程度后导致心功能损害为主的综合征。在临床上这两组疾病常常合并存在，且随着年龄的增加而增加。国内外的慢性心力衰竭指南均推荐使用心脏选择性β受体阻滞剂，但是临床医师遇到COPD合并CHF患者因担心β受体阻滞剂的不良反而拒绝或回避使用。近年来越来越多的证据表明，心脏选择性β受体阻滞剂在COPD合并CHF患者中没有明显的不良反应，且安全性得到证实，没有证据显示其降低肺通气功能如第1秒用力呼气量（FEV1）。但是在临床实际操作中有研究提示使用β受体阻滞剂亦可能导致病情恶化。笔者通过观察认为COPD合并CHF患者是否使用心脏选择性β受体阻滞剂时要采用 “个体化”策略。 　　[关键词] 慢性阻塞性肺疾病；慢性心力衰竭；β受体阻滞剂 　　[中图分类号] R563 [文献标识码] B [文章编号] 2095-0616（2014）04-50-04 　　Discussion of Beta-blocker in the treatment of chronic obstructive pulmonary disease complicated with chronic heart failure 　　ZHAO Huachang 　　Sichuan 81 Rehabilitation Centre，Chengdu 611135，China 　　[Abstract] Chronic obstructive pulmonary disease（COPD） is one of the common diseases in respiratory system， and a group of systemic inflammatory diseases which are positively correlated to ages； chronic heart failure（CHF） is a syndrome characterized by impaired cardiac functions which are caused by hypertension and coronary heart disease to a certain developmental stage. The two groups of diseases usually co-exist clinically and become severe along with the ages.The CHF guides， home and abroad， both recommend cardioselective beta-blocker， but clinical physicians， considering its adverse effects， tend to refuse or avoid the use of beta-blocker on patients with COPD complicated with CHF. In recent years， increasing evidence shows that the beta-blocker in the treatment of COPD complicated with CHF does not have significant adverse effects， and its safety has been confirmed. No evidence shows that its function in reducing pulmonary ventilation equals to FEV1. In clinical practices， however， relevant studies warn that the beta-blocker may lead to condition deterioration. Through observation， the current author suggests that the strategy of individualization may be adopted for patients with COPD complicated with CHF when receiving cardioselective beta-blocker. 　　[Key words] Chronic obstructive pulmonary di