Koga Y, Toshima H, Tanaka M, Kajiyama K
Third Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Cardiovasc Drugs Ther. 1994 Feb;8(1):83-8. doi: 10.1007/BF00877093.
The therapeutic approach to dilated cardiomyopathy (DCM) still remains nonspecific and symptomatic, since no specific etiology is identified. Nevertheless, the recent introduction of angiotensin converting enzyme (ACE) inhibitors and beta-blockers greatly improved the treatment of DCM. The poor prognosis of patients with DCM encourages maximal aggressive attempts to prevent progression of ventricular dysfunction rather than to wait for treatable symptoms. To achieve this goal, vasodilators, particularly ACE inhibitors, now appear to be essential for the treatment of DCM. Digitalis is added unless contraindicated by adverse effects. Diuretics should be used only to relieve congestive symptoms. In the presence of sinus tachycardia or ventricular arrhythmias, beta-blockers are the next choice in our practice. When congestive symptoms or low output state are not controlled with vasodilators, diuretics, and digitalis, inotropic agents are indicated, with or without mechanical assist devices. For severely ill patients unresponsive to maximal medical management, heart transplantation is needed.
由于未确定具体病因，扩张型心肌病（DCM）的治疗方法仍然是非特异性的且以对症治疗为主。然而，血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂的近期应用极大地改善了DCM的治疗。DCM患者预后较差，这促使人们积极采取措施预防心室功能障碍的进展，而不是等待出现可治疗的症状。为实现这一目标，血管扩张剂，尤其是ACE抑制剂，目前似乎是DCM治疗的关键。除非有不良反应禁忌，否则应加用洋地黄。利尿剂仅应用于缓解充血症状。在存在窦性心动过速或室性心律失常的情况下，β受体阻滞剂是我们临床实践中的次选药物。当充血症状或低输出状态不能通过血管扩张剂、利尿剂和洋地黄控制时，则需使用正性肌力药物，可联合或不联合机械辅助装置。对于经最大程度药物治疗仍无反应的重症患者，需要进行心脏移植。
