急性心衰治疗若干进展.ppt

急性心力衰竭药物治疗的若干进展;内 容;急性失代偿性心衰的预后 ; Acute heart failure with systolic dysfunction ;ADHF的药物治疗终于取得了一些进展;奈西立肽(Nesiritide，人类BNP) – 一种激素样物质，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;In patients with evidence of severely 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.;;5个研究的荟萃分析：奈西立肽对肾功能影响;Mortality Within 30 Days of Treatment Associated With Nesiritide or Control Therapy With Overall Risk Ratio Calculated by Mantel-Haenszel Test Using a Fixed-Effects Model.;ASCEND-HF奈西立肽治疗失代偿性心衰患者临床疗效的短期研究;NHLBI Heart Failure Clinical Research Network;Purpose;;入选标准;Interventions;Why is this study being done? Does Nesiritide decrease re-hospitalization or death in 30 days? Does Nesiritide decrease symptoms of dyspnea at 6 and 24 hrs after drug initiated? ;Nursing Roles;;;30天复合终点;;肾脏安全性;对ASCEND-HF评价;内 容;Diuretics and Heart Failure;Diuretics and PCWP;;;If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose. (Level of Evidence: C). ;The Hospitalized Patient;急性心衰患者利尿剂使用的指征及剂量;Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE);Aims;;主要终点 ;Patient Global Assessment VAS AUC:Q12 vs. Continuous;Patient Global Assessment VAS AUC:Low vs. High Intensification;Secondary Endpoints:Low vs. High Intensification;死亡、心衰再住院或再进急诊室的复合终点两种给药方式、两种剂量的比较;Change in Creatinine at 72 hours;对DOSE研究的评价;研究的局限性;Thank you very much!;患者基本特征;患者基本特征;