Kiowski W, Sütsch G, Fatio R, Schalcher C, Brunner-LaRocca H P
Abteilung Kardiologie, Universitätsspital, Zürich.
Schweiz Med Wochenschr. 1997 Dec 6;127(49):2026-34.
Improvement of symptoms and, accordingly, quality of life, as well as prolongation of life, are the objectives of drug therapy in congestive heart failure patients. Diuretics are most effective in relieving symptoms related to congestion, and angiotensin converting enzyme inhibitors improve exercise capacity, reduce the incidence of decompensations and hence hospitalizations, and prolong life. Angiotensin type-1 receptor antagonists also seem to improve survival, while digoxin improves symptoms and morbidity but not survival in patients in sinus rhythm. The value of prophylactic antiarrhythmic therapy with amiodarone and oral anticoagulation in the presence of sinus rhythm is not established, and the role of newer dihydropyridine calcium antagonists and betablockers is also not precisely defined. These agents should only be considered in selected cases after careful consideration of potential advantages and risks, and should usually be used as an addition to established therapy. Better understanding of the pathophysiology of congestive heart failure will lead to the development of new treatment concepts, the clinical relevance of which will have to be tested in appropriately designed clinical trials.
改善症状以及相应地提高生活质量，同时延长寿命，是充血性心力衰竭患者药物治疗的目标。利尿剂在缓解与充血相关的症状方面最为有效，而血管紧张素转换酶抑制剂可提高运动能力，降低失代偿发生率，从而减少住院次数，并延长寿命。血管紧张素1型受体拮抗剂似乎也能提高生存率，而地高辛可改善症状和发病率，但对窦性心律患者的生存率无影响。胺碘酮预防性抗心律失常治疗以及窦性心律时口服抗凝治疗的价值尚未确立，新型二氢吡啶类钙拮抗剂和β受体阻滞剂的作用也未得到确切界定。这些药物仅应在仔细权衡潜在益处和风险后，在特定病例中考虑使用，并且通常应作为既定治疗的补充。对充血性心力衰竭病理生理学的更好理解将促使新治疗理念的发展，其临床相关性必须在适当设计的临床试验中进行检验。
