治疗慢性心衰的药物.pptVIP

Vasodilators 扩血管药 α-adrenergic blocker 酚妥拉明（α受体阻断药） sodium nitroprusside 硝普钠 (NO donor) Usage: used for short-term release of symptoms, by reducing preload and afterload 酚妥拉明用药举例 Adverse effects: tachycardia (reflex SNS activation), avoid long-term and large doses use 硝普钠须避光使用，过量可致氰化物中毒 * * Pharmacotherapy of Congestive Heart Failure充血性心力衰竭的药物治疗 Definition and Clinical Features慢性心力衰竭(充血性心力衰竭) 心脏在正常充盈压时无法提供有效的前向射血，心脏收缩功能下降，同时心室舒张末压增加，心腔残余血液增加，导致肺循环和体循环淤血 Congestive heart failure (chronic heart failure, CHF) is a complex of symptoms--shortness of breath, tachycardia, fatigue, and congestion--that are related to the inadequate perfusion of tissue during exertion and to the retention of fluid. 慢性心衰的呼吸困难、心率增加、乏力、淤血等缘于组织灌注不足及体液潴留 Definition and Clinical Features慢性心力衰竭(充血性心力衰竭) Congestive heart failure (chronic heart failure, CHF) is the pathophysiologic state in which the heart is unable to pump blood at a rate commensurate with相称 the tissue requirements, or can do so only from an elevated filling pressure.心输出量不能满足组织代谢需求,或需通过升高充盈压代偿 Its primary cause is that the heart fails to provide adequate output at normal filling pressures, which is associated with a syndrome of reduced contraction capacity as well as pulmonary and systemic venous congestion.主要原因是心脏在正常充盈压时无法提供有效的前向射血，导致心脏收缩功能功能下降以及肺循环和体循环淤血 Systemic and Pulmonary Circulation When left ventricle fails Left ventricular end-diastolic pressure 左室舒张末压↑ LAP左房压↑ Pulmonary cap wedge pressure 肺毛细血管锲压↑ Left ventricle contraction↓ 左室射血↓ Thickening of the respiratory membrane reduces O2 exchange Enlarged heart (Contraction↓LVEDP↑) and pulmonary congestion (O2 Exchange↓) Clinical Features—Orthopnea特征与鉴别 Exertional dyspnea, nocturnal paroxysmal dyspnea and orthopnea—pulmonary congestion 早期运动性呼吸困难、夜间阵发性呼吸困难，急性加重呈端坐呼吸--肺淤血 为左心衰特征 Hypertension, Myocardial Hypertrophy and Diastole Dysfunction心肌肥厚与舒张功能障碍 Normal Hypertension Diastolic and Systolic Heart Failure舒张性心衰与收缩性心衰均表现为呼吸困难(肺淤血) 78 yo Woma