Bertel O, Gerber A
Medizinische Klinik, Stadtspital Triemli, Zürich.
Ther Umsch. 1991 Aug;48(8):535-42.
In acute as well as in chronic ischemic heart disease, congestive heart failure indicates a poor prognosis. Treatment after acute myocardial infarction should differentiate between specific subsets. In cardiogenic shock due to extensive ischemic damage, acute revascularization by PTCA or CABG improves the otherwise poor outcome substantially. In congestive heart failure, pre- and afterload reduction by nitrates should be combined with dopamine if systolic blood pressure is below 100 mmHG or dobutamine if an inotropic substance is necessary despite systolic blood pressure greater than 100 mmHg. Amrinone is a potent alternative which combines positive inotropic and vasodilating properties. In chronic ischemic heart disease, congestive heart failure is a clearly defined indication for complete revascularization, if possible. As to drug treatment, progression of the disease characterized by a cardiomyopathy of overload as well as neurohormonal and peripheral maladaptation should be stopped in parallel with symptom relief. Therefore, ACE-Inhibitors are combined very early with diuretic treatment, and digitalis should be added in refractory patients.
在急性和慢性缺血性心脏病中，充血性心力衰竭都预示着预后不良。急性心肌梗死后的治疗应区分不同的亚组。在因广泛缺血损伤导致的心源性休克中，通过经皮冠状动脉腔内血管成形术（PTCA）或冠状动脉旁路移植术（CABG）进行急性血运重建可显著改善原本不佳的预后。在充血性心力衰竭中，如果收缩压低于100 mmHg，硝酸盐类药物减轻前负荷和后负荷的治疗应与多巴胺联合使用；如果尽管收缩压高于100 mmHg但仍需要使用正性肌力药物，则应与多巴酚丁胺联合使用。氨力农是一种有效的替代药物，它兼具正性肌力和血管舒张特性。在慢性缺血性心脏病中，充血性心力衰竭如果可能的话，是进行完全血运重建的明确指征。至于药物治疗，在缓解症状的同时，应以超负荷心肌病以及神经激素和外周适应不良为特征的疾病进展应予以阻止。因此，血管紧张素转换酶抑制剂（ACE抑制剂）应尽早与利尿剂治疗联合使用，对于难治性患者应加用洋地黄。
