β受体阻滞剂在PCI中的应用.ppt

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1、β受体阻滞剂在PCI术的应用提纲◆β受体阻滞剂药理◆心率增快增加冠心病患者的临床事件◆β受体阻滞剂在PCI围手术期的应用药理学及作用机制主要机制：对抗儿茶酚胺类肾上腺素能递质毒性尤其是通过β1受体介导的心脏毒性，是此类药物发挥心血管保护作用。其他机制：1.抗高血压作用2.抗心肌缺血作用3.阻断肾小球旁细胞β1受体，抑制肾素-AngII-醛固酮系统。4.改善心脏功能增加LVEF:5.抗心律失常作用6.其他：抑制β肾上腺素能通路介导的心肌细胞凋亡、抑制血小板聚集、减少对粥样硬化斑块的机械应激、防止斑块破裂等。心率增快增加冠心病患者的风险！Theef

2、fectofheartrateonlocalhaemodynamicforcesontheendothelium.Mechanismswherebyanelevatedheartrateleadstoadverseoutcomesinpatientswithcoronaryarterydisease.ImpactofLeftVentricularEjectionFractiononClinicalOutcomesOverFiveYearsAfterInfarct-RelatedCoronaryArteryRecanalization(fromt

3、heOccludedArteryTrial[OAT])Inconclusion,optimalmedicaltherapyremainstheoveralltreatmentofchoiceforstablepatientswithapersistenttotalocclusionoftheinfarct-relatedarteryafteracutemyocardialinfarction,irrespectiveofthebaselineEF.Inpatientswithnormalormoderatelyimpairedleftventr

4、icularcontractility,PCIreducedtheneedforsubsequentrevascularizationbutdidnototherwiseimproveoutcomes.(AmJCardiol2010;105:10–16)包括美托洛尔在内的最佳药物治疗仍然是冠心病治疗的基石！β阻滞剂在急性心肌梗死的应用Setting/indicationClassLeveli.v.administrationForreliefofischaemicpainTocontrolhypertension,sinustachycardi

5、aPrimarypreventionofsuddencardiacdeathSustainedventriculartachycardiaSupraventriculartachyarrhythmiasTolimitinfarctsizeAllpatientswithoutcontraindicationsOraladministrationAllpatientswithoutcontraindicationsIIIIIIIaIIbIBBBCCAAAβ阻滞剂在慢性稳定性心绞痛的应用Expertconsensusdocumentonβ-adren

6、ergicreceptorblockers.EuropeanHeartJournal.2004,25:1341–1362.Setting/indicationClassLevelPreviousinfarctionToimprovesurvivalToreducereinfarctionToprevent/controlischaemiaNopreviousinfarctionToimprovesurvivalToreducereinfarctionToprevent/controlischaemiaIIIIIIAAACBAHeartRatea

7、sanIndependentPrognosticRiskFactorinPatientswithAcuteMyocardialInfarctionUndergoingPrimaryPercutaneousCoronaryInterventionCONCLUSION:InpatientswithacutemyocardialinfarctionundergoingprimaryPCI,elevatedheartrate(80bpmorgreater)identifiesthoseatincreasedriskofdeath.Itisunknown

8、whetherheartratereductionwillresultinimprovedoutcomeinthissettingofpatients