Eichhorn E J
Department of Veterans Affairs Hospital, University of Texas, Southwestern Medical Center, Dallas 75216, USA.
J Card Fail. 2000 Jun;6(2 Suppl 1):40-6.
Recognition of the role of the sympathetic nervous system in chronic heart failure has resulted in dramatic changes in the way heart failure is viewed, providing strong evidence for the therapeutic role for beta-adrenergic blocking agents. This treatment strategy does not provide short-term hemodynamic improvement and may even worsen symptoms initially. However, beta-blockers can be administered with good or even excellent tolerability by slowly withdrawing adrenergic support to the failing heart. Results of clinical trials have shown that long-term treatment with beta-blockers improves ventricular function and reduces mortality rates in patients with mild-to-moderate heart failure. Although the improvement in ventricular function is a beta-blocker class effect, there are distinct differences in antiadrenergic activity and tolerability among the first-, second-, and third-generation agents. These differences--as well as practical strategies for dose titration and the management of decompensation--are the focus of this article.
对交感神经系统在慢性心力衰竭中作用的认识，已使人们对心力衰竭的看法发生了巨大变化，为β-肾上腺素能阻滞剂的治疗作用提供了有力证据。这种治疗策略并不能带来短期血流动力学改善，甚至可能在最初使症状恶化。然而，通过缓慢减少对衰竭心脏的肾上腺素能支持，β受体阻滞剂可以以良好甚至极佳的耐受性给药。临床试验结果表明，β受体阻滞剂长期治疗可改善轻至中度心力衰竭患者的心室功能并降低死亡率。虽然心室功能的改善是β受体阻滞剂类药物的共同作用，但第一代、第二代和第三代药物在抗肾上腺素能活性和耐受性方面存在明显差异。这些差异以及剂量滴定和失代偿管理的实用策略是本文的重点。
