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自本世纪初直至七十年代,心力表竭的处理方面确无明显进展,但近几年来出现了两类新的治疗方式:即血管扩张剂及非洋地黄类的心肌收缩增强剂的应用。目前各国学者正在开展积极研究,以期明确此两大类新药的药理作用与临床应用问题。当心肌收缩发生缺陷或血循环负荷过度时,心脏的收缩功能发生障碍,引起某些代偿机制来维持心脏的工作:1.Starling 机理,即心脏前负荷的增加使心肌肌节伸长,从而维持心脏的排血功能;2.肾上腺素性心脏神经和肾上腺髓质均释放儿茶酚胺,使心脏的收缩力增强;3.心肌肥厚,伴或不伴心腔扩张,使心脏收缩组织的量有所增加。在心力衰竭开始期,通过代偿机制,心脏收缩功能往往保持在比较正常水平上,但实际上心肌收缩性已有了减退。充血性心力衰竭的治疗策略:原则上,治疗策略不外乎:1.增加心肌的收缩力;2.减少心脏的工作负荷;3.控制盐与水的潴留,也即控制体内细胞外液体的容量。在前两方面,目前有较多的新颖治疗方案,亦即为本专题讨论的主要内容。众所周知,对轻度心功能不全者,只需限制其体力活动,但大多数同时需应用洋地黄类制剂。如患者出现体内细胞外水潴留时,饮食中钠盐必须加以限制,甚或基本淡食。如限制食盐不能控制水肿,应加用利尿剂,先采用双氢克尿噻,以后用速尿,同时加用适当量的保钾药物。对难治性心力衰竭病人,应考虑加用血管扩张药,如哌唑嗪,酚妥拉明,肼苯哒嗪或巯甲丙脯氨酸,及/或新的非洋地黄类强心剂,如吡丁醇,氨联吡啶酮或 prenalterol。专题讨论会所涉及的面较广。所提出的治疗方案中,有的可以在严密观察下慎重地应用,但多数新药尚在临床鉴定阶段;虽今后其实际应用的可能性较大。讨论会上学者们提出了不少问题与一些不同看法,如虽然非洋地黄类强心剂的效果显著,但亦有学者相反地主张应用β-肾上腺素受体阻滞剂(如心得宁),后者经过重复心导管检查,证明应用β-阻滞剂后,血液动力学方面各项指标可有改进。因此,作为医学科学工作者,我们对待新生事物应该虚心学习,但作为负责诊治的临床医师,对一切缺乏科学根据的治疗方案也不应盲目接受。本刊将 AmHeart J 1981,102(3)“处理心力衰竭新方案专题讨论会”介绍给读者,以供参考。
There have been no significant advances in cardiopulmonary exhaustion since the early 2000s and the 1970s, but two new treatments have emerged in recent years: the use of vasodilators and non-digitalis myocardial contractility enhancers. At present, scholars from all over the world are conducting active research in order to clarify the pharmacological effects and clinical application issues of these two categories of new drugs. When myocardial contractility defects or excessive blood circulation overload, the heart contraction disorder occurs, causing some compensatory mechanisms to maintain the heart’s work: 1. Starling mechanism, that is, an increase in preload of the heart to make the myocardial sarong elongation to maintain Cardiac discharge; 2. Adrenergic cardiac nerves and adrenal medulla release catecholamines, so that the heart contractility; 3. Myocardial hypertrophy, with or without cardiac expansion, the amount of systolic tissue increased. At the beginning of heart failure, systolic function is often maintained at a more normal level through compensatory mechanisms, but in fact, myocardial contractility has been reduced. Treatment strategies for congestive heart failure: In principle, the treatment strategy is nothing more than: 1. To increase myocardial contractility; 2. To reduce the workload of the heart; 3. To control salt and water retention, that is, control of extracellular fluid in the body capacity. In the first two aspects, there are more novel treatment options, which are also the main topics of this symposium. As we all know, for patients with mild heart failure, only to limit their physical activity, but most of the same time need to apply digitalis preparations. In patients with extracorporeal water retention in the body, the sodium salt in the diet must be limited, or even lightly consumed. Such as restrictions on salt can not control edema, diuretics should be added, the first use of hydrochlorothiazide, furosemide later, plus the appropriate amount of potassium drugs. For patients with refractory heart failure, vasodilators such as prazosin, phentolamine, hydralazine or captopril, and / or new non-digitalis agents should be considered Pyridobutamine, Ampicillin, or Prenalterol. The symposium covers a wide range of topics. Among the proposed treatment options, some may be used with caution under close observation, but most new drugs are still in the clinical stage of identification; although there is a greater likelihood of their practical application in the future. At the symposium, scholars put forward many problems and some different opinions. Although non-digitalis type cardiotonic agents have remarkable effects, some scholars on the contrary advocate the application of β-adrenergic receptor blockers After repeated cardiac catheterization, the application of β-blocker, the hemodynamic parameters can be improved. Therefore, as a medical scientist, we should learn from new life with an open mind. But as a clinician in charge of diagnosis and treatment, we should not blindly accept any treatment plan that lacks scientific evidence. This publication will AmHeart J 1981, 102 (3) “New programs to deal with heart failure Symposium” introduced to the reader for reference.