Urbaszek W
Klinik für Innere Medizin, Bereich Medizin der Wilhelm-Pieck-Universität Rostock.
Z Gesamte Inn Med. 1988 Oct 1;43(19):533-9.
The severe and terminal cardiac insufficiency with myogenic failure and severe neurohumoral dysregulation means a problem situation in the chronically progressive or acute form of the course. The medicamentous treatment in form of the basis therapy with glycosides and saluretics may be improved by vasodilators or/and adrenergic agonists. In most cases we succeed in stabilizing the cardiovascular situation once to several times. As a rule the maximum stress only little increases. The neurohumoral dysregulation remains in different form apart from the basic disease which is no more to be corrected. Thus, in principle the vicious circle is closed. Whether the group of the so-called new inotropic and vasodilating pharmaca may essentially change the prognosis due to better influences on cardial and vascular and neurohumoral, respectively, dysfunctions, is not yet to be answered. A distinct alternative from the aspect of the cardiovascular function gives only the cardiac transplantation. The artificial heart and ventricular assist-systems, respectively, are accepted for the bridging-over up to the cardiac transplantation. The hitherto existing state of development does not yet correspond to the imaginations of a pump regulated according to the needs, disregarding material, coagulation and energy problems.
伴有心肌衰竭和严重神经体液调节失调的严重终末期心功能不全意味着慢性进行性或急性病程中的一种问题状况。以洋地黄和利尿剂为基础治疗形式的药物治疗可通过血管扩张剂或/和肾上腺素能激动剂得到改善。在大多数情况下，我们成功地使心血管状况稳定一次至数次。通常最大应激仅略有增加。除了不再能够纠正的基础疾病外，神经体液调节失调仍以不同形式存在。因此，原则上恶性循环形成。所谓的新型强心和血管扩张药物组是否能分别通过对心脏、血管和神经体液功能障碍产生更好的影响而从根本上改变预后，尚待回答。从心血管功能方面来看，唯一明显的替代方法是心脏移植。人工心脏和心室辅助系统分别被用于心脏移植前的过渡阶段。目前的发展状态尚未达到人们对按需调节泵的想象，且存在材料、凝血和能量等问题。
