Taylor S H
University Department of Cardiovascular Studies, General Infirmary, Leeds, UK.
Eur Heart J. 1996 Apr;17 Suppl B:43-56. doi: 10.1093/eurheartj/17.suppl_b.43.
Heart failure constitutes an increasing health hazard with major demands on health care resources. Recent major advances in drug treatment have yet to be translated into increased survival of heart failure patients in the community at large. Failure of diagnosis is a major factor in delaying early and adequate treatment. Echocardiography probably provides the most reliable and inexpensive instrument to confirm the diagnosis and pinpoint the mechanical components of the syndrome. The targets for therapeutic intervention may be categorized (i) haemodynamic, neuroendocrine and metabolic disorders (ii) symptoms and quality of life, (iii) morbidity and mortality risks. Symptoms and quality of life are the prime concerns of the physician in the treatment in the individual patient. Selection of anti-heart failure drugs used should be based on knowledge of the impact on the pathophysiological disorders and on the morbidity and mortality risks. Diuretics, vasodilators and ACE-inhibitors are now accepted as standard treatment, particularly when used in combination. Controversy continues to surround the efficacy of digitalis glycosides; they improve symptoms in some patients but their impact on morbidity and mortality risks is still uncertain. Even with standard treatments, may practical therapeutic questions remain, one of which is what is the most efficacious dose of each anti-heart failure drug which, when used in combination, will give the maximum improvement in quality of life and greatest extension of survival? Despite available treatment with diuretics, digitalis, vasodilators and ACE-inhibitors, the morbidity and mortality risks of congestive heart failure remain high. None of these drug groups significantly modulates the excessive excitation of the sympathoadrenal system, one of the two major neuroendocrine hazards of heart failure. For this reason, amongst the many newer drugs in development, the beta-adrenoceptor antagonists hold considerable promise as the next step towards a more comprehensive treatment of congestive heart failure.
心力衰竭对医疗资源的需求巨大，且对健康构成的危害日益增加。药物治疗方面的近期重大进展尚未转化为广大社区中心力衰竭患者生存率的提高。诊断失误是延误早期充分治疗的主要因素。超声心动图可能是确诊并查明该综合征机械性因素的最可靠且最经济的手段。治疗干预的目标可分为：（i）血流动力学、神经内分泌和代谢紊乱；（ii）症状和生活质量；（iii）发病风险和死亡风险。症状和生活质量是医生治疗个体患者时首要关注的问题。所用抗心力衰竭药物的选择应基于对其对病理生理紊乱以及发病风险和死亡风险影响的了解。利尿剂、血管扩张剂和血管紧张素转换酶抑制剂现已被公认为标准治疗药物，尤其是联合使用时。洋地黄苷的疗效仍存在争议；它们能改善部分患者的症状，但其对发病风险和死亡风险的影响仍不确定。即便采用标准治疗，仍存在诸多实际治疗问题，其中之一是每种抗心力衰竭药物的最有效剂量是多少，联合使用时能最大程度改善生活质量并最大程度延长生存期？尽管有利尿剂、洋地黄、血管扩张剂和血管紧张素转换酶抑制剂可供治疗，但充血性心力衰竭的发病风险和死亡风险仍然很高。这些药物类别均未显著调节交感肾上腺系统的过度兴奋，而交感肾上腺系统过度兴奋是心力衰竭两大主要神经内分泌危害之一。因此，在众多正在研发的新型药物中，β肾上腺素能受体拮抗剂有望成为迈向更全面治疗充血性心力衰竭的下一步药物。
