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用血管扩张剂(VSL)治疗心衰已有20余年,是治疗急慢性心衰重要方法之一,疗效显著,但如果选择错误或使用不当,常导致有害的后果.一、如何选用 VSL1.按心衰亚型选药根据血动学及临床特点,可将心衰分为三个亚型:(1)肺充血型:LVFP>25mmHg,CI2.5～3.0L/min/m~2,临床上出现明显肺瘀血体征,而无周围灌注不足表现,血压多正常;宜选用硝酸甘油(NTG)、消心痛(ISDN)等静脉扩张剂;(2)低排高阻型:LVFP14～25mmHg,CI<2.5L/min/m~2,周围灌注不足的临床表现明显,但 LVEDV 增高并不显著,故可无肺瘀血体征,血压常升高.宜选用酚妥拉明(Regitine)、肼苯哒嗪(HDZ)及苯苄胺等小动脉扩张剂;(3)混合型:LVF P>25mmHg.CI<2.5L/min/m~2,临床上既有肺瘀血体征
Treatment of heart failure with vasodilator (VSL) for more than 20 years is one of the important ways to treat acute and chronic heart failure, with significant efficacy, but if the wrong choice or improper use, often lead to harmful consequences. Heart failure subtype drug selection according to the characteristics of blood and clinical features can be divided into three subtypes of heart failure: (1) pulmonary congestion type: LVFP> 25mmHg, CI2.5 ~ 3.0L / min / m ~ 2, clinical Obvious signs of pulmonary blood stasis, and no peripheral perfusion inadequate performance, more normal blood pressure; should choose nitroglycerin (NTG), heartburn (ISDN) and other intravenous agents; (2) low row high resistance type: LVFP14 ~ 25mmHg, CI <2.5L / min / m ~ 2, the clinical manifestations of insufficient perfusion around the obvious, but LVEDV increased is not significant, it can be no signs of pulmonary blood stasis, often elevated blood pressure.It is appropriate to use phentolamine (Regitine), hydrazine Benzodiazepine (HDZ) and benzene benzyl amine and other arteriolar dilators; (3) Mixed type: LVF P> 25mmHg.CI <2.5L / min / m ~ 2, clinically both signs of pulmonary blood stasis