醛固酮受体拮抗剂在慢性收缩性心力衰竭患者的应用Aldosteronereceptorantagonists(mineralocorticoidreceptorantagonises)作用机理入选标准：NYHA心功能分级Ⅲ~Ⅳ级，已接受ACEI和袢利尿剂治疗，LVEF≤35%的慢性心力衰竭患者。排除标准：原发病为瓣膜病，UA,等，Cr>221μmol/L,K>5mmol/L。基线临床特征亚组分析入选标准：AMI后3~14d,LVEF≤40%，伴心衰相关的肺部湿啰音、胸片提示肺水肿、S3；或合并糖尿病。排除标准：Cr>221μmol/L，K>5mmol/L，应用其它潴钾利尿剂等。theRateofDeathfromAnyCausetheRateofDeathfromCardiovascularCausesorHospitalizationforCardiovascularEventstheRateofSuddenDeathfromCardiacCausesK<4mmol/LK≥4mmol/LP=0.29Cr<97μmol/LCr≥97μmol/LP=0.03醛固酮受体拮抗剂适应症慢性收缩性心衰的基本治疗方案从“黄金搭档”（ACEI加β受体阻滞剂）转变为“金三角”（前两者加醛固酮受体拮抗剂）醛固酮受体拮抗剂SvenssonM,etal.JCardFail,2004,10(4):297-303.RAILESMETHODSPatientscriteriaforexclusionwereaserumCr>221µmol/LorK>5.0mmol/L.Follow-upmeasurementsofserumK,wereconductedevery4weeksforthefirst12weeks,thenevery3monthsforupto1yearandevery6monthsthereafteruntiltheendofthestudy…….Studymedicationcouldbewithheldintheeventofserioushyperkalemia,aserumCr≥354µmol/L.AlthoughtheentrycriteriaforRAILESexcludedpatientswithaCr>221µmol/L,themajorityofpatientshadmuchlowercreatinine(95%ofpatientshadCr≤150.3µmol/L）EPHESUSExclusion:serumCr>221µmol/LorK>5.0mmol/L.Follow-upvisitsoccurredatoneandfourweeks,threemonths,andeverythreemonthsthereafteruntiltheterminationofthestudy.Theserumpotassiumconcentrationwasmeasured48hoursaftertheinitiationoftreatment,atone,four,andfiveweeks,atallscheduledstudyvisits,andwithinoneweekafteranychangeofdose.Crshouldbe≤221μmol/Linmenor≤176.8umol/Linwomen(oreGFR>30mL/min/1.73m2),andKshouldbe≤5.0mmol/L.CarefulmonitoringofK,renalfunction,anddiureticdosingshouldbeperformedatinitiationandcloselyfollowedthereaftertominimizeriskofhyperkalemiaandrenalinsufficiency.(CLASSI,LevelofEvidence:A)AldosteronereceptorantagonistsarerecommendedtoInappropriateuseofaldosteronereceptorantagonistsispotentiallyharmfulbecauseoflife-threateninghyperkalemiaorrenalinsufficiencywhenserumcreatinineis>221μmol/Linmenor>176.8μmol/Linwomen(orGFR<30mL/min/1.73m2),and/orK>5.0mmol/L.(CLASSⅢLevelofEvidence:B)若起始用药后血K升高≤6mmol/L或出现肾功能恶化，则不加量直至血K<5mmol/l。确定高钾