Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
Am J Health Syst Pharm. 2011 Jan 1;68(1):21-35. doi: 10.2146/ajhp100202.
Drug therapies for patients with acute heart failure syndromes (AHFS) are reviewed, including clinical practice guideline recommendations for the treatment of hospitalized patients with heart failure (HF).
AHFS may be defined as new-onset, gradual, or rapidly worsening HF signs and symptoms that require urgent therapy. Clinical practice guidelines from the American College of Cardiology Foundation-American Heart Association, Heart Failure Society of America, and European Society of Cardiology offer recommendations for the management of AHFS, addressing the role of diuretics, vasodilators, and inotropes. The guidelines emphasize the utility of vasodilators for patients with signs and symptoms of pulmonary congestion, including pulmonary edema or severe hypertension or both, who have not responded to diuretics. The early initiation of vasoactive medications, including diuretics and vasodilators, has been linked to improved outcomes in some reports. Conversely, the use of inotropes is de-emphasized, particularly as part of the routine management of these patients. Newer agents, including vasopressin antagonists, have also been approved recently but are not addressed by the clinical practice guidelines. The guidelines address the importance of initiating and optimizing evidence-based oral medications for long-term use, including angiotensin-converting-enzyme (ACE) inhibitors, angiotensin-receptor blockers, β-blockers, and aldosterone antagonists, during the patient's hospital stay in an effort to address long-term outcomes.
Drug therapy of AHFS may include diuretics, vasodilators, morphine, ACE inhibitors, digoxin, inotropes, and vasopressin antagonists. Clinical practice guidelines for patients with AHFS provide a useful mechanism to incorporate available evidence and standards of practice into patient care.
对急性心力衰竭综合征（AHFS）患者的药物治疗进行综述，包括治疗住院心力衰竭（HF）患者的临床实践指南建议。
AHFS 可定义为新发、逐渐或迅速恶化的 HF 体征和症状，需要紧急治疗。美国心脏病学会基金会-美国心脏协会、美国心力衰竭学会和欧洲心脏病学会的临床实践指南为 AHFS 的管理提供了建议，涉及利尿剂、血管扩张剂和正性肌力药的作用。这些指南强调血管扩张剂在有肺充血迹象和症状（包括肺水肿或严重高血压或两者兼有）且对利尿剂无反应的患者中的作用。一些报告表明，早期使用血管活性药物（包括利尿剂和血管扩张剂）与改善结局相关。相反，不强调使用正性肌力药，特别是作为这些患者常规管理的一部分。最近还批准了一些新型药物，包括血管加压素拮抗剂，但临床实践指南未涉及这些药物。该指南强调在患者住院期间开始并优化长期使用的基于证据的口服药物的重要性，包括血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和醛固酮拮抗剂，以努力解决长期结局问题。
AHFS 的药物治疗可能包括利尿剂、血管扩张剂、吗啡、ACE 抑制剂、地高辛、正性肌力药和血管加压素拮抗剂。AHFS 患者的临床实践指南为将现有证据和实践标准纳入患者护理提供了有用的机制。
