受体阻滞剂在中的应用优选ppt资料

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,11/7/2009,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,受体阻滞剂在中的应用(yngyng),第一页，共33页。,免责(min z)声明,此幻灯片内容仅代表(dibio)讲者本人个人看法，旨在进行学术交流，并不作为临床处方的推荐。,倍他乐克缓释片在中国的适应症为：心绞痛、高血压、症状稳定的心力衰竭（详细内容请参见美托洛尔缓释片说明书）。,倍他乐克缓释片常用剂量为：高血压：47.5-95mg/d；心绞痛：95-190mg/d；症状稳定的心衰：11.375或23.75-190mg/d。,如需处方倍他乐克缓释片，请参考其中国说明书。,第二页，共33页。,提 纲,受体阻滞剂药理,心率增快增加冠心病患者的临床(ln chun)事件,受体阻滞剂在PCI围手术期的应用,第三页，共33页。,药理学及作用(zuyng)机制,主要机制：对抗儿茶酚胺类肾上腺素能递质毒性尤其是通过1受体介导的心脏毒性，是此类药物发挥心血管保护作用。,其他机制：,1.抗高血压作用,2.抗心肌缺血作用,3.阻断肾小球旁细胞1受体，抑制肾素-AngII-醛固酮系统。,4.改善心脏功能增加LVEF:,5.抗心律失常作用,6.其他：抑制肾上腺素能通路介导的心肌细胞凋亡、抑制血小板聚集、减少(jinsho)对粥样硬化斑块的机械应激、防止斑块破裂等。,第四页，共33页。,心率增快增加(zngji)冠心病患者的风险！,第五页，共33页。,The effect of heart rate on local haemodynamic forces on the endothelium.,Mechanisms whereby an elevated heart rate leads to adverse outcomes in patients with coronary artery disease.,第六页，共33页。,Impact of Left Ventricular Ejection Fraction on Clinical Outcomes,Over Five Years After Infarct-Related Coronary Artery,Recanalization(from the Occluded Artery Trial OAT),In conclusion,optimal medical therapy remains the overall treatment of choice for stable patients with a persistent total occlusion of the infarct-related artery after acute myocardial infarction,irrespective of the baseline EF.In patients with normal or moderately impaired left ventricular contractility,PCI reduced the need for subsequent revascularization but did not otherwise improve outcomes.,(Am J Cardiol 2010;105:10 16),包括美托洛尔在内的最佳药物治疗仍然是冠心病治疗的基石！,第七页，共33页。,阻滞剂在急性心肌梗死(xn j n s)的应用,Setting/indication,Class,Level,i.v.administration,For relief of ischaemic pain,To control hypertension,sinus tachycardia,Primary prevention of sudden cardiac death,Sustained ventricular tachycardia,Supraventricular tachyarrhythmias,To limit infarct size,All patients without contraindications,Oral administration,All patients without contraindications,I,I,I,I,I,IIa,IIb,I,B,B,B,C,C,A,A,A,第八页，共33页。,al,Mortality Benefit of Beta-Blockade After Successful Elective Percutaneous Coronary Intervention.,Sustained ventricular tachycardia,Mechanisms whereby an elevated heart rate leads to adverse outcomes in patients with coronary artery disease.,第二十五页，共33页。,Kernis,Kishore J.,European Heart Journal.,Marmur,et al.,If confirmed in the clinical,To control hypertension,sinus tachycardia,GP IIb/IIIa Inhibitors,受体阻滞剂在PCI围手术(shush)期的应用,第二十七页，共33页。,术前静脉注射(zhsh)BB与未注射(zhsh)组随访三个月及一年生存率的比较,3%achieved an average HR of 50 to 60 beat/min throughout the hospital stay.,Cardioprotective Effect of Prior-Blocker Therapy in Reducing Creatine Kinase-MB Elevation After Coronary Intervention.,In conclusion,optimal medical therapy remains the overall treatment of choice for stable patients with a persistent total occlusion of the infarct-related artery after acute myocardial infarction,irrespective of the baseline EF.,阻滞剂在慢性(mn xng)稳定性心绞痛的应用,Expert consensus document on-adrenergic receptor blockers.European Heart Journal.2004,25:13411362.,Setting/indication,Class,Level,Previous infarction,To improve survival,To reduce reinfarction,To prevent/control ischaemia,No previous infarction,To improve survival,To reduce reinfarction,To prevent/control ischaemia,I,I,I,I,I,I,A,A,A,C,B,A,第九页，共33页。,Heart Rate as an Independent Prognostic Risk Factor in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention,CONCLUSION,:In patients with acute myocardial infarction undergoing primary PCI,elevated,heart rate(80 bpm or greater)identifies those at increased risk of death.It is unknown whether heart rate reduction will result in improved outcome in this setting of patients.,急性心肌梗死患者即使行PCI，心率增快的患者发生院内死亡(swng)的风险明显增高！,第十页，共33页。,阻滞剂在心肌梗塞后二级预防(yfng)的应用,Setting/indication,Class,Level,All patients without contraindications,indenitely,To improve survival,To prevent reinfarction,Primary prevention of sudden cardiac death,To prevent/treat late ventricular arrhythmias,I,I,I,I,IIa,A,A,A,A,B,第十一页，共33页。,阻滞剂在非ST段抬高(ti o)ACS的应用,Setting/indication,Class,Level,Early benet,reduction of ischaemia,Early benet,prevention MI,Long-term secondary prevention,I,I,I,B,B,B,第十二页，共33页。,实践与指南的差距：阻滞剂在中国冠心病患者(hunzh)中使用现状,中华医学会心血管病学分会中华心血管病杂志编辑(binj)委员会.肾上腺素能受体阻滞剂在心血管疾病应用专家共识.,使用率低,使用(shyng)时间滞后,剂量较低,获益渐少,第十三页，共33页。,受体阻滞剂在PCI围手术(shush)期的应用,第十四页，共33页。,受体阻断剂在非心脏手术(shush)期间的使用一直受到重视!,第十五页，共33页。,但是(dnsh)在PCI围手术期间的使用？,2021 Focused Updates:ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction.,2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention.,.,Antithrombotic,：,1.UH,LMWH,2.GP IIb/IIIa Inhibitors,3.Bivalirudin,-block,？,statin,？,Antiplatelet,：,1.Aspirin,2.clopidogrel,第十六页，共33页。,受体阻断剂在PCI围手术(shush)期间的使用,术前,术中,术后,第十七页，共33页。,PCI术前使用(shyng)阻滞剂渐少术后CK-MB的上升,Samin K.Sharma,Annapoorna Kini,Jonathan D.Marmur,et al.,Cardioprotective Effect of Prior-Blocker Therapy in Reducing Creatine Kinase-MB Elevation After Coron