心衰教案精品医学ppt课件

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1、南方医科大学南方医院心血管内科许顶立2000年我国住院心衰患者(2178例)的病因分析:冠心病占55.7%;扩张性心肌病占7.5%高血压占13.9%;其他占14.0%风湿性瓣膜病占8.9%;中华心血管病杂志2003,30(1):24-27调查时间2000年,调查的总人数18912人中华心血管病杂志2003,31(1):3-6Framingham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:

2、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)0.5PROBABILITY0.4OF0.3DEATH0.20.1006121824303642VHefT-1MONTHSNEnglJMed1986;314:1547504030%Placebo20n=3403p=0.810DIGOXINn=33970DIG012243648NEnglJMed1997;336:52

3、5MonthsNEnglJMed1991;325:1468-1475Followup:0.5~5.7year(average2.3years)ACEISURVIVAL0.80.7PlaceboPROBABILITY0.6p<0.001OFDEATH0.50.4p<0.002NYHAIV0.3127EnalaprilEnalapril126Placebo0.2(2.5~20mg,Bid)Follow-up:188d(1d~20mon)0.1CONSENSUS00123456789101112NEnglJMed1987;

4、316:1429MONTHSACEISURVIVAL50p=0.0036Placebo40n=1284%30MORTALITYEnalapril20n=1285(2.5~10mg,Bid)n=2589CHF10-NYHAII-III-EF<350SOLVD(Treatment)0612182430364248NEnglJM1991;325:293MonthsACEISURVIVAL50p=0.30Placebo40n=2117%30MORTALITY20Enalapriln=2111n=422810(2.5~10mg

5、,Bid)NoCHFsymptomsEF<350SOLVD(Prevention)0612182430364248NEnglJMed1992;327:685MonthsACEISURVIVAL30AsymptomaticventricularPlacebodysfunctionpostMIn=111620Mortality,Captopril%n=111510n=22313-16dayspostAMIEF<40²-19%12.5---150mg/dayp=0.019SAVE001234NEnglJMed1992;32

6、7:669Years194metoprolol(10mg/day,To100~150mg/day)189PlaceboFollowup:12~18months34%Lancet1993;342:1441-1446MortalityCAPRICORN(Carvedilol)Atameanfollow-upof1year:Mortality11.0%placebogroup7.2%metoprololgroupwithsimilarrelativereductionsinsuddendeathanddeathduetoh

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