臨床藥理hfppt課件(參考版)
2025-01-11 04:10本頁面
【正文】 51 (24):23019. Steps in the treatment of chronic heart failure. ________________________________________ 1. Reduce workload of the heart a. Limit activity level b. Reduce weight c. Control hypertension 2. Restrict sodium 3. Restrict water (rarely required) 4. Give diuretics 5. Give ACE inhibitor and digitalis1 6. Give bblockers to patients with stable class IIIII heart failure 7. Give vasodilators __________________________________________ 1Many clinicians use angiotensinconverting enzyme inhibitors before digitalis. Summary ? On the basis of several recent largescale clinical trials it appears that reduction in ventricular volume and perhaps a reduction in the risk of lethal ventricular arrhythmias are the keys to longterm improvement and survival of patients with CHF ? Emphasis on therapy for heart failure has shifted in the past several years from acute interventions to improve hemodynamics and inotropic state to longterm therapies that might slow or halt the progression of the disease ? Future therapies will most likely involve therapeutic strategies that prevent or minimize the remodeling processes in the heart and vasculature, and thereby arrest the syndrome at early stages of cardiac dysfunction 。 ? Concurrent use of two diuretics with different sites of action may be needed in patients who do not respond well to a single oral diuretic ? The most mon adverse effect of diuretic therapy is potassium depletion which can be prevented by use of supplemental potassium, an ACE inhibitor, or a potassiumsparing diuretic (spironolactone or amiloride) ? Aldosterone Antagonists Recent clinical trials indicate that adding spironolactone (螺內(nèi)酯 )to standard treatment can significantly decrease mortality in patients with severe heart failure Effect of spironolactone on survival in patients with moderate or severe congestive heart failure in a randomized doubleblind clinical study. (Reproduced, with permission, from Pitt B et al: The effect of spironolactone on morbidity and mortality in patients with se
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