儿科心血管系统-heart failure英文二部分

HEARTFAILUREManagementofHeartFailure

TreatmentStrategies:AmelioratesymptomsMaintaincardiacfunctionalstateReducemortalityrateReducehospitalization

Treatment1.Thecausemustberemoved2.Generalmanagement:bedrest,mitigate，oxygeninhalation，reductionofsaltintake3.DrugTreatment

DrugTreatmentPositiveinotropicagents—cardiacglycosides,phosphodiesteraseinhibitorsVasodilatorsDiureticsAngiotensinconvertingenzymeinhibitors(ACEI)Beta-blockers治疗

洋地黄类药物：正性肌力，负性传导，负性心率；直接抑制过度的神经内分泌系统。临床常用制剂：地高辛；西地兰。常用剂量：地高辛口服化量：＜2岁0.05-0.06mg/kg，＞2岁0.03-0.05mg/kg，维持量为化量的1/5。西地兰静注化量：＜2岁0.03-0.04mg/kg，＞2岁0.02-0.03mg/kg。新生儿用量更少，取婴儿量的1/2至2/3。治疗---洋地黄类药物使用方法

化量（饱和量）：适用于急性心衰或重症心衰，首次用化量的1/2量，余量分2次（1/4、1/4），q4h-q6h或q8h。

维持量：适用于慢性心衰或轻症心衰，维持量为化量的1/5量，分2次口服；或者化量后需继续维持者，于化量后12小时开始予维持量。治疗---洋地黄类药物注意事项：用药前了解洋地黄情况；避免用钙剂；注意纠正低血钾。洋地黄中毒表现：心律失常；消化道症状；神经系统症状等。处理：停用洋地黄及利尿剂；口服补钾；必要时用抗心律失常药。

DiureticsRelievethecongestionstatusbyeliminationofsodiumandwater.Indicatedinpulmonarycongestionwithdyspneaandralesandgeneralizededema,ascitesAgentsused:Thiazides—chlorothiazide,chlothalidoneLoopdiuretics—furosimide,bumetanide,ethacrynicacidPotassium-sparingdiuretics—spirolectone,triamterene,amilorideSideeffects:hypokalemia,hyperglycemiaACE-Inhibitors

RationalesoftheACEItreatmentforheartfailure:DecreasesperipheralcirculatoryresistanceDecreasesthebloodvolumeDecreasesthesympatheticactivityInhibitionoftheremodelingprocessACE-InhibitorsShort-termeffectsSymptomaticimprovement:approximately2/3ofcaseswithsevereheartfailureshowdiurea,improvementindyspneaandlessedema.Hemodynamicimprovement: increasedcardiacoutputby25%-30%reductionofPCWPby20%decreasedperipheralresistanceby30%BP—drop10%-15%Heartrate—slightlyreducsedN.B.1stdosehypotension,transientelevationofBUNandcreatininACEItreatmentofH.F.Long-termeffects:Reductionofmortalityandpreservationofcardiacfunction.SAVEstudy:Cases:postacutemyocardialinfarctionwithEF<40%

CaptoprilControl PCaseNo. 1115