心力衰竭的诊断与治疗百度文库上传.pptVIP

* * * Given the publication of recent compelling and positive trials, it is probable that most physicians are now aware of the benefits of b-adrenergic blockade in patients with heart failure. Yet, the majority of patients eligible for b-blocker therapy are not being treated with these drugs. Why, then, do physicians under-prescribe b-blockers in heart failure patients? It is of note that b-blockers have been contraindicated for the last 25 years in the treatment of heart failure due to their negative chronotropic and inotropic effects. Several likely scenarios present themselves. In some patients, b-blockers have been associated with the risk of worsening heart failure. Another hurdle involves the amount of time that physicians can devote to initiating and uptitrating b-blockers in heart failure patients and the negative implications this may have on reimbursement.1 Studies such as MERIT-HF demonstrate that the barriers to b-blocker therapy can be overcome. The long term morbidity and mortality benefits of b-blocker therapy in heart failure far outweigh short-term negative perceptions of the use of these life saving agents.1 TOPROL-XL is contraindicated in severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated heart failure, and sick sinus syndrome (unless a permanent pacemaker is in place). Slide and Notes Reference 1. Califf RM, O’Connor CM. b-blocker therapy for heart failure. The evidence is in, now the work begins. JAMA. 2000;283:1335-1337. 32 * 由于我们国家有巨大的人口负担，加之近年来人口快速老龄化，另外由于生活水平的提高和生活节奏的加快，产生了众多的高血压患者。由于医疗技术水平的提高，早期血管重建技术挽救了大量心脏病人，所以我们见到的心力衰竭病人很多。另由于很多患者对心力衰竭的低知晓率和低治疗率，这些都是产生了大量心力衰竭病人的原因，要引起我们的重视。 。 慢性心力衰竭现代治疗方案 NYHA 分类 I II III IV 利尿剂 ACEI β-blocker* Digoxin 醛固酮拮抗剂 运动/他汀类 * In stage IV use β-blocker only if patient is stable Gomberg-Maitland, et al. Arch Intern Med. 2001; 161: 342-352 尽管存在大量的临床试验证据，专家共识、治疗指南， ------各种有效治疗方案