急性心衰治疗若干进展PPT课件

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A Report of the ACCF/ AHA Task精F选oprpcte on Practice Guidelines
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• BNP可用于治疗急性心衰，患者的体征为肺充血/水肿， BP > 90mmHg
• 静注BNP时，其输注速率从0.015到0.03 ug/kg/min均可， 无论开始是否进行负荷推注（2ug/kg）。不推荐和其他静 注血管扩张剂联用
Duke Heart Failure Research Pager: 970-0736
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• Baylor • Duke • Harvard • Mayo Clinic • Minnesota • Montreal • Morehouse • Utah • Vermont
NHLBI Heart Failure Clinical Research Network
––20% at 30 days20% at 30 days ––50% at 6 months50% at 6 months • MortalityMortality ––11.6% at 30 days11.6% at 30 days ––33.1% at 12 months ––50% at 5 years50% at 5 years
急性心力衰竭药物治疗的 若干进展
2011.4
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内容
• ASCEND-HF • DOSE
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急性失代偿性心衰的预后
• Median length of hospital stay: 6 days • Hospital readmissionsHospital readmissions
Severe Symptomatic Fluid Overload
I IIa IIb III
In patients with evidence of severely symptomatic fluid overload in the absence of systemic hypotension, vasodilators such as intravenous nitroglycerin, nitroprusside or neseritide can be beneficial when added to diuretics and/or in those who do not respond to diuretics alone.
• ADHF治疗新药乏善可陈
• 在不同医院和不同医生之间利尿剂的应用剂量和 应用方式均大相径庭，缺乏安全性和有效性的高 质量研究
• 终于有些进展
✓ ASCEND-HF（AHA 2010) ✓ DOSE最新结果（N Engl J Med 3月3号在线）
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• 奈西立肽(Nesiritide，人类BNP) –
Rev Cardiovasc Med. 2002;3(suppl 4)
精Ar选chppInttern Med. 2002;162Intern Med. 2002;162
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Acute heart failure with systolic dysfunction
Furosemide+/- Vasodilator
肾功能恶化的定义：SCr>0.5 mg/dL.
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CirculaБайду номын сангаасion. 2005;111:1487-1491 10
Mortality Within 30 Days of Treatment Associated With Nesiritide or Control Therapy With Overall Risk Ratio Calculated by Mantel-Haenszel Test Using a Fixed-Effects Model.
SBP>100 mmHg
SBP 85-100 mmHg
SBP < 85 mmHg
Vasodilator (NTG,SPN,BNP)
Vasodilator and/or inotropic (dobutamine, PDEI or levosimendan)
inotropic and/or Dopamine>5ug/kg/min
Control, n/N (%) Nesiritide, n/N (%)
4/29 (14) 2/42 (5)
9/102 (9) 45/216 (21)
9/83 (11) 69/472 (15)
15/74 (20) 15/85 (18) 36/203 (18) 74/273 (27) 29/162 (18) 169/797 (21)
荟萃3个小规模 试验： NSGET VMAC PROACTION
Copyright restrictions may apply.
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Sackner-Bernstein, J. D. et al. JAMA 2005;293:1900-1905
ASCEND-HF
奈西立肽治疗失代偿性心衰患者 临床疗效的短期研究
Good response: Oral therapy ACEI……
No response: Reconsider mechanistic therapy inotropic agents
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ESC2005急性心衰诊断和治疗指南
ADHF的药物治疗终于取得了一些进展
• 在过去30年中，急性失代偿性心衰（ADHF）的 药物治疗几乎没有进展
• 一种激素样物质，除扩张动脉和静脉外， 还可促进利钠利尿
• 降低患者左室充盈压和呼吸困难程度，缓 解症状
• FDA approved 2001
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The Effects of Nesiritide on Neurohormones
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The Hospitalized Patient
ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure 2008
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5个研究的荟萃分析：奈西立肽对肾功能影响
study
311 325 326 VMAC Precedent Totals