Kamath Sandeep A, Yancy Clyde W
University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9047, USA.
Postgrad Med. 2005 Dec;118(6 Suppl Beta-Blockers):12-20. doi: 10.3810/pgm.12.2005.suppl43.227.
Excessive activation of the sympathetic nervous system and local release of norepinephrine are detrimental to the failing myocardium. Blockade of the beta-adrenergic receptor system is now a potent strategy. Earlier concerns that beta-blockade would thwart compensatory mechanisms that preserve myocardial function are no longer valid in the compensated state. Over the past 2 decades, a large body of evidence has accrued indicating marked benefits in symptoms and survival as well as favorable changes in myocardial architecture with beta-blocker therapy in patients who have compensated heart failure with impaired systolic function. This article outlines the rationale for beta-blocker therapy, examines both the early and the large-scale clinical work with beta-blocker therapy for congestive heart failure, highlights additional novel aspects of beta-blocker therapy for heart failure, and outlines expert recommendations about the use of beta-blockers in patients with systolic dysfunction.
交感神经系统的过度激活和去甲肾上腺素的局部释放对衰竭的心肌有害。β-肾上腺素能受体系统的阻断现在是一种有效的策略。早期关于β受体阻滞剂会阻碍维持心肌功能的代偿机制的担忧在代偿状态下已不再成立。在过去20年中，大量证据表明，对于收缩功能受损的代偿性心力衰竭患者，β受体阻滞剂治疗在症状和生存率方面有显著益处，并且心肌结构也有有利变化。本文概述了β受体阻滞剂治疗的理论依据，审视了β受体阻滞剂治疗充血性心力衰竭的早期和大规模临床研究，强调了β受体阻滞剂治疗心力衰竭的其他新方面，并概述了关于在收缩功能障碍患者中使用β受体阻滞剂的专家建议。
