Rickenbacher P, Buser P, Osswald S, Pfisterer M
Abteilung für Intensivmedizin, DIM, Universitätskliniken, Kantonsspital Basel.
Schweiz Med Wochenschr. 1996 May 25;126(21):933-45.
Congestive heart failure is a frequent disorder with an estimated prevalence of 0.4-2% in the general population. Despite recent advances in our understanding of the pathophysiology of this disorder and new developments in its treatment, the prognosis of heart failure remains poor. All patients with heart failure should undergo diagnostic evaluation to determine the type of cardiac dysfunction, establish its etiology and orient treatment. Angiotensin converting enzyme (ACE) inhibitors, diuretics and digoxin are the standard therapy for chronic congestive heart failure caused by systolic dysfunction. ACE inhibitors are indicated in all stages of heart failure, even in asymptomatic patients. Diuretics should be added in the presence of fluid retention. Digoxin remains an important component in the management of refractory symptoms and atrial fibrillation. Symptomatic improvement and reduced morbidity have been shown with all these drugs. However, improved survival has been documented for ACE inhibitors only. Currently, numerous drugs with different mechanisms of action are being evaluated in ongoing clinical trials. Promising results have been published, mainly with beta-receptor blockers and newer positive inotropic substances. Rapidly growing evidence from basic research will advance our understanding of heart failure and hopefully pave the way for new preventive and therapeutic strategies in the near future.
充血性心力衰竭是一种常见疾病，在普通人群中的估计患病率为0.4%-2%。尽管我们对该疾病病理生理学的认识最近有所进展，且其治疗也有新的发展，但心力衰竭的预后仍然很差。所有心力衰竭患者都应接受诊断评估，以确定心脏功能障碍的类型，明确其病因并指导治疗。血管紧张素转换酶（ACE）抑制剂、利尿剂和地高辛是治疗收缩功能障碍引起的慢性充血性心力衰竭的标准疗法。ACE抑制剂适用于心力衰竭的各个阶段，即使是无症状患者。存在液体潴留时应加用利尿剂。地高辛仍然是难治性症状和房颤管理中的重要组成部分。所有这些药物都已显示出症状改善和发病率降低的效果。然而，只有ACE抑制剂被证明能提高生存率。目前，正在进行的临床试验中正在评估许多具有不同作用机制的药物。已经发表了一些有前景的结果，主要是关于β受体阻滞剂和新型正性肌力药物。基础研究中迅速增加的证据将增进我们对心力衰竭的理解，并有望在不久的将来为新的预防和治疗策略铺平道路。
