Scott Robert L
Mayo Clinic Specialty Building, Mayo Clinic Arizona, 5779 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Cardiol Clin. 2008 Feb;26(1):73-7, vii. doi: 10.1016/j.ccl.2007.10.004.
The utilization of angiotensin-II attenuating agents is the standard of care in the management of patients with left ventricular dysfunction regardless of the etiology. The most effective agents of this group includes both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARB). Given the worse outcomes noted in those patients who have coronary artery disease, efforts to optimize appropriate pharmacotherapy in this population is imperative. There does appear to be some advantage in the combination of ACE+ARB in chronic left ventricular dysfunction patients. In those patients that have sustained a recent myocardial infarction with concomitant left ventricular dysfunction, the combination of ACE+ARB does not improve survival and in fact might exacerbate renal dysfunction as well as hypotension. The appropriate employment of agents that attenuate the effects of angiotensin-II should be a priority in the care and management of the left ventricular dysfunction patient.
无论病因如何，使用血管紧张素II衰减剂都是治疗左心室功能不全患者的标准治疗方法。该组中最有效的药物包括血管紧张素转换酶（ACE）抑制剂和血管紧张素受体拮抗剂（ARB）。鉴于冠心病患者的预后较差，因此必须努力在该人群中优化适当的药物治疗。对于慢性左心室功能不全患者，ACE+ARB联合使用似乎有一定优势。在近期发生心肌梗死并伴有左心室功能不全的患者中，ACE+ARB联合使用并不能提高生存率，事实上还可能加重肾功能不全和低血压。在左心室功能不全患者的护理和管理中，合理使用能减弱血管紧张素II作用的药物应是首要任务。
