Follath F
Departement für Innere Medizin, Universitätsspital Zürich.
Praxis (Bern 1994). 1997 Feb 11;86(7):254-7.
Improvement of symptoms, increase in exercise capacity and prevention of disease progression are the aims of drug therapy in patients with congestive heart failure. At present only the ACE inhibitors are able to achieve all therapeutic targets and should therefore be regarded as drugs of first choice in systolic dysfunction. Diuretics are also necessary in most patients since they rapidly reduce pulmonary congestion and peripheral oedema, but have no documented beneficial long term effects on the course of CHF. Digoxin remains a useful drug to treat symptomatic patients who do not respond adequately to the combination of ACE inhibitors and diuretics, as well as in patients with atrial fibrillation. However, a reduction of mortality by digitalis glycosides cannot be expected. A new trend in the treatment of CHF is the utilisation of beta blockers. These drugs showed positive effects in chronic CHF in several studies, particularly in patients with dilated cardiomyopathy. Newer drugs such as carvedilol, seem to improve the symptoms and reduce complications even in CHF due to coronary artery disease. The role of beta blockers in the routine management of patients with heart failure requires further evaluation.
改善症状、提高运动能力以及预防疾病进展是充血性心力衰竭患者药物治疗的目标。目前只有血管紧张素转换酶（ACE）抑制剂能够实现所有治疗目标，因此应被视为收缩功能障碍的首选药物。大多数患者也需要使用利尿剂，因为它们能迅速减轻肺淤血和外周水肿，但尚无证据表明其对慢性心力衰竭病程有长期有益影响。地高辛对于那些对ACE抑制剂和利尿剂联合治疗反应不佳的有症状患者以及房颤患者仍然是一种有用的药物。然而，不能期望洋地黄苷降低死亡率。治疗慢性心力衰竭的一个新趋势是使用β受体阻滞剂。几项研究表明，这些药物对慢性心力衰竭有积极作用，尤其是对扩张型心肌病患者。较新的药物如卡维地洛，似乎即使在冠心病所致的慢性心力衰竭中也能改善症状并减少并发症。β受体阻滞剂在心力衰竭患者常规管理中的作用需要进一步评估。
