慢性心衰治疗.pptVIP

2021/3/17 * 心率 0 1 2 3 4 5 65 70 75 80 85 心率（次/分） 竖线代表1个标准误 * P=0.0022, P=0.0034, P=0.0040 * 美托洛尔 达利全? 2021/3/17 * COMET-历时最长规模最大的慢性心力衰竭临床试验 随访（病人年） 3,441 3,991 8,863 12,050 14,646 CIBIS-Ⅱ MERIT-HF SOLVD ATLAS COMET 0 3,000 6,000 9,000 12,000 15,000 2021/3/17 * 总结 　COMET是第一个直接比较2个β受体阻滞剂对慢性心衰死亡率影响临床研究 　COMET随访了至少14000病人年,使其成为观察时间最长,规模最大的慢性心衰研究 　COMET证明:达利全?（卡维地洛）组的生存益处显著高于美托洛尔组,达17%(p =0.0017) 　COMET证明了具有全面的β1、β2和α1 受体阻滞作用的达利全?（卡维地洛）优于传统的选择性β1受体阻滞剂 　COMET论证了达利全?（卡维地洛）是慢性心衰应用β受体阻滞剂时的最佳选择 * * * * Pathophysiology of Congestive Heart Failure. Determinants of ventricular function. Ventricular function, and cardiac function in general, depends upon the interaction of four factors that regulate the volume of blood expelled by the heart (the cardiac output): contractility, preload, afterload, and heart rate. The first three determine the volume of blood expelled with each beat (the stroke or ejection volume), while the heart rate affects the cardiac output by varying the number of contractions per unit time. These four factors, which are intrinsic regulators of heart function, are all influenced by the nervous system. In the failing heart, especially in ischemic heart disease, it is also important to consider some purely mechanical factors, such as the synergy of ventricular contraction, the integrity of the septum, and the competence of the atrioventricular valves. * * The pathophysiology of heart failure is complex. Neurohormonal activation plays a central role in the onset and progression of heart failure. Activation of both the sympathetic nervous system and the renin-angiotensin system exert direct adverse effects on the heart. * * AVP=精氨酸血管加压素 * * 心衰高危人群，如高血压、冠心病、心梗以及有心肌病病史的患者，无论是否伴有心衰症状，均应给予定期心超检查，以早期诊断心衰。根据心超检查结果，如EF45%或心脏扩大LVEDD55mm收缩性心力衰竭；EF45%舒张功能降低　E/A1.0舒张性心功能不全，然后根据纽约心功能分级判断患者的心功能，再根据不同的心功能分级，给予不同的治疗 * * Figure 7-11. Brain natriuretic peptide (BNP) as a diagnostic tool in heart failure (see also Fig. 7-12). Point-of-care BNP levels have been