培达-血管外科课件

,培达,让,PAD,患者走的更长、更远,培达让PAD患者走的更长、更远,培达,的临床应用,改善步行功能缺损和生活质量,改善下肢,PAD,缺血性症状：,溃疡、肢痛、冷感及间歇性跛行等,成功支架手术后，口服西洛他唑联用,可显著降低再狭窄率并且安全性良好,培达的临床应用改善步行功能缺损和生活质量,下肢,PAD,的患病率流行病学调查,时间 作者与文献 例数,(,例,),年龄,(,岁,),人群,患病率,(%,，男,/,女,),1987 Gofin R,Kark JD,et al,3,1592,35,Jerusalem,血脂研究人群,4.6(4.2/5.4),1991 Fowkes FG,Housley E,et al,4,1592,5574,Edinburgh,动脉研究人群,9.0,1993 Newman AB,Siscovick DS,et al,5,5084,65,心血管健康研究人群,12.4,1998 Meijer WT,et al6 7715,55,Rotterdam,研究人群,19.1(16.9/20.5),1998 Hooi JD,Stoffers HE,et al,7,3650,4078,Limburg,周围动脉疾病研究人群,12.4,2000 Gray RS,Fabsitz RR,et al,8,4549,4574,Strong Heart,研究人群,5.3,2001 Hirsch AT,Criqui MH,et al,9,6979,5069;70,PARTNERS,计划人群,29,2002 Murabito JM,Evans JC,et al,10,3313,40,Framingham,研究人群,3.6,2003,李小鹰，王洁 等,11-13,2124,60-95,北京万寿路地区老年居民,16.4(12.7/18.1),2007,管珩，田浩明 等,16,1347,50,糖尿病患者,19.4(18.3/20.4),2005,刘成国,阮连生 等,14,2668,35,浙江舟山渔民,2.1(3/1.2),2006,魏毅东，胡大一 等,15,2115,32-91,代谢综合征人群,22.5(21.7/23.4),2007,李贤，武阳丰 等,17,18140,35,MUCA,研究人群,6.0(5.4/9.3),MUCA,：中国心血管病流行病学多中心合作研究,60,岁的普通人群,PAD,发病率为,16.4%,；,50,岁并有糖尿病的人群,PAD,发病率为,19.4%,下肢PAD的患病率流行病学调查时间 作者与文献,Recommendation 15,:,Pharmacotherapy for symptoms of intermittent claudication,A 3-to-6-month course of cilostazol should be first-line pharmacotherapy for the relief of claudication symptoms,as evidence shows both an improvement in treadmill exercise performance and in quality of lifeA.,Publication:,Jan,200,7,，,Representative of Asia,，,Prof.H.,Shigematsu,Tokyo Univ.,培达,，,TASCII,指南推荐一线首选药物,间歇性跛行症状的药物疗法：,推荐,15,:,间歇性跛行的药物疗法,西洛他唑（,3,6,个月）作为缓解跛行症状的一线药物治疗方法,，,证据表明培达可同时改善踏车运动能力和生活质量,。,A,Recommendation 15:Publication:,培达,，,ACC/AHA,治疗,PAD,指南推荐一线首选,西洛他唑可对无心力衰竭的下肢,PAD,患者和间歇性跛,行患者症状改善和提高步行距离有效（证据水平：,A,级）,无心力衰竭的凡影响生活方式的跛行患者均可考虑采用,西洛他唑治疗（证据水平：,A,级）,跛行（,类）,培达，ACC/AHA治疗PAD指南推荐一线首选跛行（类,药物,研究者,样本数,剂量,疗程（月）,增加,MWD*(%),P,值,结果评估,己酮可可碱,Porter et al.,128,1.2 g/day orally,6,12,0.19,ND,Lindgarde et al.,150,1.2 g/day orally,6,21,0.09,ND,Dawson et al.,698,1.2 g/day orally,6,0,0.82,阴性,Hood et al.,511,多种剂量,多种,30,0.05,ND,西洛他唑,Dawson et al.,81,200 mg/day orally,3,Money et al.,239,200 mg/day orally,4,Beebe et al.,516,200 mg/day orally,6,Dawson et al.,698,200 mg/day orally,6,萘呋胺,Moody et al.,188,600 mg/day orally,6,11,0.27,ND,Trubestein et al.,104,500 mg/day orally,3,16,NS,ND,Adhoute et al.,94,633 mg/day orally,6,32,0.001,阳性,Propionyl,levocarnitine,Brevetti et al.,245,13 g/day orally,6,27,0.049,ND,Brevetti et al.,114,2 g/day orally,12,41,0.01,阳性,前列腺素,Belch et al.,80,前列腺素,E1,multi-dose,注射,2,70,0.01,阳性,Diehm et al.,213,前列腺素,E1,60,g/day,注射,2,41,0.05,ND,Lievre et al.,83,贝前列素,120 g/day orally,3,50,NS,ND,Lievre et al.,424,贝前列素,120 g/day orally,6,25,0.004,阳性,噻氯匹定,Balsano et al.,121,500 mg/day orally,21,33,0.01,ND,Hiatt,W.R.:N Engl J Med,344(21),1608,2001,*,增加,MWD,指与安慰剂比较对最大步行距离的增加百分率,结果评估中包括了对患者生活质量改善的,.,调查问卷,NS,表示结果不明显没有,P,值提供,.ND,表示没有调查结果,对比前列腺素和己酮可可碱，,培达,显著改善最大步行距离和生活质量,外周动脉疾病和间歇性跛行的药物治疗,73,0.01,32,0.001,82,0.001,33,0.001,阳性,阳性,阳性,阳性,药物研究者样本数剂量疗程（月）增加P 值结果评估己酮可可碱,Beebe HG,Dawson DL,et.al.,Arch Int Med,1999Sep.27;159(17):2041-50,培达,改善步行功能缺损,4,8,16,20,24,0,20,40,60,80,100,120,140,Mean,(Meters),Weeks,Placebo,(N=140),100mg bid,(N=140),50mg bid,(N=139),一项新的针对间歇性跛行的药物治疗,最大步行距离相对基线的变化,最大步行距离,Beebe HG,Dawson DL,et.al.A,Dawson,et al.Circulation,.,1998;98(17):1-12.,%Change from,Baseline MWD(mean),0,10,20,30,40,50,0,4,8,12,16,20,24,Weeks of Treatment,培达,100 mg BID,(n=205),*,:P 0.05 at all time points,*,*,*,*,*,*,+113 m (+371 ft),+66%increase,己酮可可碱,400 mg TID,(n=212),安慰剂,(n=226),培达,对最大步行距离的改善明显优于对照组,西洛他唑对间歇性跛行有效：一项多中心、随机、前瞻性双盲研究的结果,最大步行距离的改变,Dawson,et al.Circulation.,神坂謙：薬理治療,20,（,9,）,3685,1992.,对 象,合并糖尿病的,ASO,患者,29,例,（,A,B,I0.8,以下,）,给药量,西洛他唑,200mg/,天,12,周,：,p0.01,：,p0.001,：,p0.1,：,p0.05,冷 感,发 绀,麻 感,疼 痛,0w,n=26,2w,n=20,4w,n=24,8w,n=25,12w,n=23,0w,n=7,2w,n=3,4w,n=6,8w,n=7,12w,n=7,0w,n=23,2w,n=17,4w,n=21,8w,n=22,12w,n=22,0w,n=12,2w,n=9,4w,n=12,8w,n=12,12w,n=12,100,80,60,40,20,0,(%),100,80,60,40,20,0,(%),100,80,60,40,20,0,(%),100,80,60,40,20,0,(%),显著,轻度,中度,无,培达,服用,3,个月明显,改善,糖尿病的,ASO,患者的冷感、麻感、发绀、疼痛,一项西洛他唑对糖尿病患者,ASO,的研究,神坂謙：薬理治療20（9）,3685,19,培达,服用,12,个月明显改善糖尿病患者,冷感、麻感、间歇性跛行和,ABI,指数,12,6,服药前,(,月,),0.9,0.8,0.7,0.6,*,*,平均值,标准差,*,p0.001,ABI,Yasukuni Shikano,Jpn Pharmacol Ther,20(2),625,1992.,长期服用西洛他唑改善自觉症状、神经病变和,ABI,(,培达,100200mg/day;,612,月,),自觉症状的改善率,(,服药,12,个月后,),冷感,(,n,=24)63%,麻木,(n=30)76%,间歇性跛行,(n=17)65%,(,自觉症状改善,1,级以上,),一项西洛他唑对糖尿病患者外周动脉疾病长期疗效的研究,糖尿病患者,:,冷感和麻木,ABI 0.9,(n=46),培达服用12个月明显改善糖尿病患者126服药前(月)0.9,方法：,:,确诊的,DM,并有周围神经传导障碍患者,50,例,随机分为西洛他唑组,(50mg,bid),和维生素组,(B,12,500g,B,1,100mg,肌注,qd),各治疗,8,周,测定自身治疗前后的运动神经传导速度（,MCV,）和感觉神经传导速度（,SCV,）,其中纵坐标为神经传导速度,(m/s),。,胡静芳,等,.,中国临床康复,2004,8(18):3523,培达组,MCV,维生素组,MCV,SCV,SCV,p,0.05,p0.01,西洛他唑对糖尿病患者周围神经传导速度及其肢体疼痛、麻木症状的影响,培达,用药周能改善上下肢神经的运动感觉传导速度,而维生素仅能对上肢神经感觉传导速度有效,方法：:确诊的DM并有周围神经传导障碍患者50例,随机分为西,目的,:,西洛他唑,EVT,支架后减少血管狭窄及降低,TRL,及,TVR,首要终点,:,2,年后,TVR,次要终点,:,2,年后再狭窄率；,TLR,；主要心脏不良事件,MACE,s,（包括全因死亡，非致死性心梗，脑卒中，血管重建术以及截肢）,随访,:,24,个月,股动脉疾病合并间歇性跛行患者,(n=78),西洛他唑,200 mg/d,+,阿司匹林,81-100 mg,+,塞氯匹定,200 mg/d,R,24,个月,西洛他唑组,(n=39,39,例成功,EVT,),对照组,(n=39,37,例成功,EVT,),阿司匹林,81-100 mg,+,塞氯匹定,20