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治疗慢性心衰的药物DefinitionandClinicalFeatures慢性心力衰竭(充血性心力衰竭)DefinitionandClinicalFeatures慢性心力衰竭(充血性心力衰竭)SystemicandPulmonaryCirculationWhenleftventriclefailsThickeningoftherespiratorymembranereducesO2exchangeEnlargedheart(Contraction↓LVEDP↑)andpulmonarycongestion(O2Exchange↓)ClinicalFeatures—Orthopnea特征与鉴别Hypertension,MyocardialHypertrophyandDiastoleDysfunction心肌肥厚与舒张功能障碍DiastolicandSystolicHeartFailure舒张性心衰与收缩性心衰均表现为呼吸困难(肺淤血)Whentheheartfails,arterialpressurereduceswhichcausesthebaroreceptorresponseandexcitationofsympatheticnervoussystem(SNS)andrenin-angiotensin-aldosteronesystem(RAAS).心输出量下降导致反射性交感神经系统及肾素血管紧张素醛固酮系统兴奋Compensationmechanismsduringchronicheartfailure心衰代偿机制的不利影响PharmacotherapyofCHF治疗慢性心衰的药物TherapeuticAimsofCHFClinicalconditionsthatprecipitatedeteriorationofCHFPharmacotherapyofCHF治疗慢性心衰的药物化学结构基本骨架Positiveinotropicagents正性肌力药Cardiacglycosides强心苷MechanismCardiacglycosides强心苷洋地黄体内过程与给药特点AdverseEffectsofCardiacglycosides强心苷的不良反应Positiveinotropicagents正性肌力药Cardiacglycosides强心苷地高辛的应用与血药浓度监测UseofSympathomimeticsinCHF交感激动药在慢性心衰中的应用与争议Diuretics利尿剂Diuretics利尿剂Vasodilators扩血管药Useofβ-blockerinCHFβ受体阻断药在慢性心衰中的应用Heartfunctionchangeswiththeuseofβ-blockerinCHFInhibitorsofRenin-AngiotensinSystem抑制肾素血管紧张素系统的药物PharmacotherapyofCHF治疗慢性心衰的药物PharmacotherapyofCHF治疗慢性心衰的药物心力衰竭新的分类方法图示TrymildexercisetherapyforyourCHFpatientsaftersymptomrelief补充幻灯CecilMedicine24thedition开篇第一段Feb16,2004OsmoticDiuretics渗透性利尿药(脱水利尿药)OsmoticDiuretics渗透性利尿药(脱水利尿药)抗心力衰竭药物复习案例充血性心力衰竭患者治疗中的部分问题