心衰教案-2008

《心衰教案-2008》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、南方医科大学南方医院心血管内科许顶立•冠心病占55.7%;•高血压占13.9%;•风湿性瓣膜病占8.9%;•扩张性心肌病占7.5%•其他占14.0%Framingham的研究（1948年～1988年）：有症状的心力衰竭患者，男性患者平均存活时间为3.2年，女性为5.4年。中华心血管病杂志2002,30:7-23中华心血管病杂志2002,30:7-23中华心血管病杂志2002,30:7-23中华心血管病杂志2002,30:7-23NITRATESSURVIVAL0.7Placebo(273)0.6Prazosin(183)Hz+ISDN(186)

2、0.5PROBABILITY0.4OF0.3DEATH0.20.1006121824303642VHefT-1MONTHSNEnglJMed1986;314:1547DIGOXINn=3397NEnglJMed1991;325:1468-1475Followup:0.5~5.7year(average2.3years)ACEISURVIVAL0.80.7PlaceboPROBABILITY0.6p<0.001OFDEATH0.50.4p<0.002NYHAIV0.3127EnalaprilEnalapril126Placebo0.2(2.5~2

3、0mg,Bid)Follow-up:188d(1d~20mon)0.1CONSENSUS00123456789101112NEnglJMed1987;316:1429MONTHSACEISURVIVAL50p=0.0036Placebo40n=1284%30MORTALITYEnalapril20n=1285(2.5~10mg,Bid)n=2589CHF10-NYHAII-III-EF<350SOLVD(Treatment)0612182430364248NEnglJM1991;325:293MonthsACEISURVIVAL50p=0.30

4、Placebo40n=2117%30MORTALITY20Enalapriln=2111n=422810(2.5~10mg,Bid)NoCHFsymptomsEF<350SOLVD(Prevention)0612182430364248NEnglJMed1992;327:685MonthsACEISURVIVAL30AsymptomaticventricularPlacebodysfunctionpostMIn=111620Mortality,Captopril%n=111510n=22313-16dayspostAMIEF<40²-19%12

5、.5---150mg/dayp=0.019SAVE001234NEnglJMed1992;327:669Years194metoprolol(10mg/day,To100~150mg/day)189PlaceboFollowup:12~18months34%Lancet1993;342:1441-1446MortalityCAPRICORN(Carvedilol)Atameanfollow-upof1year:Mortality11.0%placebogroup7.2%metoprololgroupwithsimilarrelativeredu

6、ctionsinsuddendeathanddeathduetoheartfailure.Lancet1999,353:2001-2007Uptitratedfrom3.125mgbidto25mgbidinintervalsofatleasttwoweeksFollowup:Mean10.4monthsNEnglJMed2001;344:1651-1658Followup:mean1.3yearFollowup:24months