ApplicationofbetablockersinthetreatmnetofpatientswithheartfailureClinicalseven-year06

FujianPronvncialHospitalB-blocker在慢性心力衰竭中的應(yīng)用

Chronicheartfailurecanimprovetheactivityofsympatheticnervoussysteminpatientswiththeextensionofdiseaseduration,itcanleadtodeteriorationofcardiovascularsystemfunction.Betablockerscaninhibittheactivityoftheneuroendocrine,thuspreventthediseaseprogression.Betablockersiswidelyusedinchronicheartfailure.PrefaceB-blocker在慢性心力衰竭中的應(yīng)用DirectoryFirst，betablockers

Second,treatmentmechanisms

Third,evidence-basedFourth,guidelinesrecommend

Fifth，rationaluseB-blocker在慢性心力衰竭中的應(yīng)用Distributed◆Humancardiaccells

hasthreebeta-blockers

β1、β2、α1◆β1andβ2receptorsinnormalhumanventricularratio:70-80/20-30%◆Heartfailure,duetoselectiveβ1receptordown,

β2receptoraccountsfor35-40%

B-blocker在慢性心力衰竭中的應(yīng)用1、Non-selective

beta-twoblockersPropranolol(普奈洛爾/心得安)and

Plugmelol(塞嗎洛爾)

Mechanism

：Inhibitionofcardiac,peripheralresistanceincreases,sothatcardiacoutputdecreased

2、selective

beta-oneblockersMetoprolol

（美托洛爾/倍他樂(lè)克）、Bisoprolol(比索洛爾/博蘇、康忻）3、Bothα1,β1,β2blockersLabetalol(拉貝洛爾)、Carvedilol(卡維地洛/達(dá)利全、絡(luò)德），Alsoknownasavasodilatoreffectofb2blockersClassificationB-blocker在慢性心力衰竭中的應(yīng)用Β-blockersusedinheartfailureBisoprolol

Metoprolol

CarvedilolB-blocker在慢性心力衰竭中的應(yīng)用Mechanismfortreatmentofheartfailure

B-blocker在慢性心力衰竭中的應(yīng)用--Totalnumberofpatientsmorethan

20,000

cases,morethan20placebo-controlledclinicalstudyhasconfirmed:

ReducetheriskofdeathReduceheartfailuresymptoms

Toimprovethepatient'sclinicalstatus

ImprovethegeneralconditionofthepatientReducethecombinedendpointofdeathandhospitalization

evidence-basedB-blocker在慢性心力衰竭中的應(yīng)用Threekindsofblockerscansignificantlyreducethemortalityrateof34-36%CHF

37%EF≤25%2289Carvedilol

COPERNICUS35%(Deathrate

41%)NYHAⅡ-Ⅳ

3991Metoprolol

MERIT-HF34%(Deathrate

44%)NYHAⅢ-Ⅳ

2647Bisoprolol

CIBISⅡMortality

CHFseverity

ThenumberBeta-blockersStudy

COMETCarvedilolvsMetoprolol＞2000NYHAⅡ-Ⅳ40%vs34%

B-blocker在慢性心力衰竭中的應(yīng)用DIG:Cardiac(digoxin)CIBISⅡ:Betablockers RAESI:DiureticsThreekindsoftreatmentonmortalityofCHFdrugsB-blocker在慢性心力衰竭中的應(yīng)用RecommendedGuide

Chinarecommendations(2009)

Indications:

①AllsystolicCHF,NYHAII,IIIlevelinstablecondition.

②InstageB,

asymptomaticorNYHAⅠlevelHFpatientsLVEF<40%ofpatients,unless

contraindicatedornottolerated,requiredapplicationofbblockersforlifeindefinitely..B-blocker在慢性心力衰竭中的應(yīng)用③NYHAⅣstageHFpatientsneedtobeinstablecondition(4dinnointravenousinjection,fluidretentionandweightisnolongerconstant),thespecialistinintensivecareundertheguidanceofadoctorbytheapplicationB-blocker在慢性心力衰竭中的應(yīng)用Contraindication

①Bronchospasmdisease

Nadololstudy:β-blockersisnotanabsolutecontraindication

，thosewithmildasthmacanNaduoluoertolerance,andthroughthelowerdosd，airwayhyperresponsivenessbenefit.②Bradycardia

(heartrate<60beats/min)③Ⅱdegreeatrioventricularblockandabove

Unlesspacemaker

④Markedfluidretention,requirealotdiureticcannotbeapplied

B-blocker在慢性心力衰竭中的應(yīng)用Rationaluse

◆Emphasisonlow-doseinitialtherapy◆Toslowthespeedofincreasing,doublingdosesof2-4weeks

◆Toachievethegoalofpatientsorthemaximumtolerateddoseofearlymorningrestingheartratedoses-----55-60beats/min(notlessthan55beats/min)

B-blocker在慢性心力衰竭中的應(yīng)用Beta-blockersDrugs

Startingdose

Conventionaltargetdose

Bisoprolol

1.25mgQD10mgQDCarvedilol

3.125mgBID25mgBIDMetoprololtartrate

6.25mgBID75mgBIDMetoprololsuccinate(sustainedrelease)

12.5-25mgQD200mgQDB-blocker在慢性心力衰竭中的應(yīng)用DeliveryNotes

(ONE)Unauthorizedwithdrawalordecrease

(TWO)IntheACEI,diuretictherapybasedontheuseβ-blocker,maintaintheinitialdryweightbeforeandaftertreatment,iffluidretention,youmustfirstuseofdiureticstodryweight

(THREE)Very

lowdose,every2to4weeks

doubledose.B-blocker在慢性心力衰竭中的應(yīng)用DeliveryNotes（FOUR）To

targetdoseormaximum

tolerateddoseoflong-termmaintenance.Targetdose：Resting,HR>60beats/min,cancontinuetouse.

（FIVE）Long-termapplication3monthslater,cansignificantlyimprovehemodynamics.

B-blocker在慢性心力衰竭中的應(yīng)用

TheonsettimeBeta-blockers

0Clinicalimprovement

Clinicaldeterioration

1–23–45–67–89–1011–12monthB-blocker在慢性心力衰竭中的應(yīng)用Notereductionprocess

Shouldbeslow,onceevery2-4daysbytheamount

Completedby2weeksConditionstablelater,continueorincreasetouseB-blocker在慢性心力衰竭中的應(yīng)用Observethecontentsoftheearly

treatment

Symptomsandsigns

Bodyweight

Heartrateandrhythm

BloodpressureB-blocker在慢性心力衰竭中的應(yīng)用Symptomsandsigns

gainweightintheinitialtreatmentof3-5daysifnotdealingwith,1-2weekslater,oftencausedbyworseningheartfailureInformthepatientweigheddailySuchasweightgain:

diureticsorACEIimmediatelyincreasetheamountofinvalid,Ifnotuseful,reduction,orstopB-blocker在慢性心力衰竭中的應(yīng)用Hypotension

Inparticularαblocker(suchas:Carvedilol)Ithanppensusuallythefirstdoseorincreasetheamountof24-48hours

ACEIorvasodilatingagentsmaybereduction

or-blockerstakenatdifferenttimesoftheday.DiureticsaregenerallynotthereductionB-blocker在慢性心力衰竭中的應(yīng)用HeartrateandrhythmBradycardiaandconductionblock