Urbaszek W, Graf B
Z Gesamte Inn Med. 1986 Feb 1;41(3):75-80.
The chronic heart insufficiency is essentially characterized by a disturbed regulative function of the peripheral circulation. These processes taking place within efforts for compensation close the chain of the vicious circle. The vasodilators with their different principles of effect affect in various places of the vegetative nervous system up to the smooth musculature of the vessels and modulate the peripheral part of the cardiovascular system. Via a changed behaviour of the impedance also with the arterial vasodilation the ejection behaviour of the insufficed hearts changes. With the increase of the ejection fraction the filling pressure can decrease, also when only the arterial branch of the periphery of the vessels is influenced. In case of an additional vasodilation of the capacity vessels greater influences of the preload are present. As a rule after the full use of the conventional therapy with digitalis and saluretics is resorted to the adjuvant therapy with vasodilators. Good experiences in the therapy of chronic heart insufficiency are present above all for hydralazine and prazosin as well as increasingly also for captopril, when vasodilating and at the same time positively inotropic medicaments are disregarded. In future, depending upon haemodynamic and neurohumoral (PNA, PRAA) findings in problematic cases and aimed additional adjuvant therapy will be aspired to.
慢性心力衰竭的基本特征是外周循环调节功能紊乱。这些在代偿过程中发生的过程构成了恶性循环的链条。血管扩张剂具有不同的作用原理，可在自主神经系统的各个部位直至血管平滑肌发挥作用，并调节心血管系统的外周部分。通过改变阻抗的行为，即使在动脉血管扩张时，衰竭心脏的射血行为也会发生变化。随着射血分数的增加，充盈压可能会降低，即使仅影响血管外周的动脉分支时也是如此。如果容量血管进一步扩张，对前负荷的影响会更大。通常在充分使用洋地黄和利尿剂的传统治疗后，会采用血管扩张剂进行辅助治疗。在慢性心力衰竭的治疗中，尤其是对于肼屈嗪和哌唑嗪，以及越来越多地对于卡托普利，都有很好的治疗经验，此时不考虑血管扩张和同时具有正性肌力作用的药物。未来，根据疑难病例的血流动力学和神经体液（PNA、PRAA）检查结果，有望进行有针对性的额外辅助治疗。
