McAlister F A, Teo K K
Division of General Internal Medicine, Ottawa Civic Hospital, Ontario, Canada.
Postgrad Med J. 1998 Nov;74(877):658-61. doi: 10.1136/pgmj.74.877.658.
A number of important questions surrounding the treatment of systolic congestive heart failure have been answered by randomised clinical trials completed within the past 2 years. In particular, these studies have established that high-dose angiotensin-converting enzyme (ACE) inhibition is more beneficial than low dose therapy, and that angiotensin II receptor antagonists are an acceptable alternative in patients unable to tolerate ACE inhibitors. Digoxin has been shown to be the only inotropic agent not associated with increased mortality, while amiodarone exerts a modest survival benefit in arrhythmiaprone patients. Beta-blockers appear to be beneficial for selected patients although their precise role remains to be defined by ongoing studies.
过去两年内完成的随机临床试验解答了一系列围绕收缩性充血性心力衰竭治疗的重要问题。特别是，这些研究证实高剂量血管紧张素转换酶（ACE）抑制治疗比低剂量治疗更有益，并且血管紧张素II受体拮抗剂对于无法耐受ACE抑制剂的患者是可接受的替代药物。地高辛已被证明是唯一一种不增加死亡率的正性肌力药物，而胺碘酮对易发生心律失常的患者有一定的生存获益。β受体阻滞剂对特定患者似乎有益，但其确切作用仍有待正在进行的研究所明确。
