急性心衰治疗若干进展汇编.pptVIP

急性心力衰竭药物治疗的 若干进展  内容 ASCEND-HF DOSE  急性失代偿性心衰的预后 Median length of hospital stay: 6 days Hospital readmissionsHospital readmissions -20% at 30 days20% at 30 day 50% at 6 months 50% at 6 months Mortality Mortality 11.6% at 30 days11. 6%at 30 days 33. 1 at 12 months 50% at 5 years50% at 5 years Arch Intern Med. 2002- 162Intern Med 2002: 162  Acute heart failure with systolic dysfunction Furosemide+/- Vasodilator SBP100 mmHg SBP 85-100 mmHg SBP s 85 mm Vasodilator Vasodilator and/or inotropic InotropIc (NTG, SPN, BNP) (dobutamine, PDEl or and/or levosimendan) Dopamines 5ug/ka/min Good No response response: Oral therapy Reconsider mechanistic therapy ACEI inotropic agents ESc2005急性心衰诊断和治疗指南  ADHF的药物治疗终于取得了一些进展 在过去30年中,急性失代偿性心衰(ADHF)的 药物治疗几乎没有进展 ADHF治疗新药乏善可陈 在不同医院和不同医生之间利尿剂的应用剂量和 应用方式均大相径庭,缺乏安全性和有效性的高 质量研究 终于有些进展 ASCEND-HF (AHA 2010 √DOSE最新结果( N Engl J Med3月3号在线)  奈西立肽( Nesiritide,类BNP) 种激素样物质,除扩张动脉和静脉外, 还可促进利钠利尿 降低患者左室充盈压和呼吸困难程度,缓 解症状 FDA approved 2001  The Effects of Nesiritide on Neurohormones 900 860P0.001 P=0.06 0 700 P0.05 670 595 600 500 曰 Before nesiritide 400 a During Nesiritide 200 100 Norepinephrine Aldosterone Endothelin-1 (pmol/L) (pg/dL)2 Abraham wret al. J Card Fail. 1998: 4 2. Aronson et al. J Am Coll CatdioL. 2001: 37(  ③ Heart The Hospitalized Patient Severe Symptomatic Fluid Overload In patients with evidence of severely I a lbⅢ symptomatic fluid overload in the absence of systemic hypotension, vasodilators such as intravenous nitroglycerin, nitroprusside or neseritide can be beneficial when added to diuretics and or in those who do not respond to diuretics alone New Report of the ACCF/AHA Task Force on Practice Guidelines  Table 29 Ind ications and dosing of i v, vasodilators in acute heart failure Vasodilator Indicat on Main side-effect Nitroglycerine Pulmanary congestionfoedema tart 10-20 - rin, increase up to Hypotension, headache Tolerance on BP 90 mmHg