课件：治疗冠心病药物.ppt

Beta-阻断剂 阻断交感对心脏的兴奋作用，减慢心率，抑制心肌收缩，降低氧耗量 对劳作型心绞痛效好，对变异性无效？ 可用于先兆心肌梗死和急性心肌梗死 钙拮抗剂 舒张动静脉血管，减轻后负荷和前负荷 冠脉解痉效果好，最适用于变异性心绞痛 要用长效药物，短效者可使血压波动过大，兴奋交感 Use beta-blockers as first-line anti-anginal therapy, unless contraindicated. Beta-blockers decrease myocardial oxygen demand by decreasing myocardial contractility, arterial (blood) pressure, and heart rate. Left ventricular perfusion is enhanced by the increased duration of diastole. Of all of the medications used in treating angina pectoris, only beta-blockers have conclusively been shown to reduce both clinical symptoms and cardiac events . However, emerging data suggest that angiotensin-converting enzyme (ACE) inhibitors and statins also reduce clinical symptoms and cardiac events . combination therapy Beta-blockers and nitrates are frequently used together in patients with chronic stable angina, because their combined use appears to be more effective than monotherapy with either agent . The concurrent use of beta-blockers attenuates the tendency of nitrates to increase sympathetic tone and cause reflex tachycardia. The potential increase in left ventricular volume, end-diastolic pressure, and wall tension, and the potential decrease in heart rate with beta-blockers, are counteracted by the concurrent use of nitroglycerin. 对心肌梗死的治疗 冠脉血栓 心肌梗死。梗塞范围大可致心源性休克，心律失常，心衰，心脏破裂，死亡率高。应尽快挽救梗塞区的心肌，缩小梗死范围。 治疗方案： 药物 溶栓治疗，t-PA，尿激酶，链激酶等。 Beta-阻断剂保护心肌，6-12小时内使用降低死亡率 镇静止痛，抗焦虑药或吗啡 冠状血管再通术，PTCA或CABG Initial therapy for acute MI is directed towards restoration of perfusion in order to salvage as much of the jeopardized myocardium as possible. This may be accomplished through medical or mechanical means, such as angioplasty or coronary artery bypass grafting （CABG）. Further treatment is based on (1) restoration of the balance between the oxygen supply and demand to prevent further ischemia, (2) pain relief, and (3) prevention and treatment of the complications that may arise. 辅助治疗 抗血小板：阿斯匹林，氯吡格雷，血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂 抗氧化剂：维生素E、C，beta-胡