xronicheskaya serdechnaya nedostatochnost

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powerpoint presentation vibor adekvatnogo lecheniya bolnix xsn xronicheskaya serdechnaya nedostatochnost – finalniy etap serdechno-sosudistogo kontinuuma sindrom, razvivayushiysya v rezultate razlichnix zabolevaniy serdechno-sosudistoy sistemi, privodyashix k snijeniyu nasosnoy funktsii serdtsa, giperaktivatsii neyrogrmonalnix sistem i proyavlyayushiysya: odishkoy serdtsebieniem povishennoy utomlyaemostyu ogranicheniem fizicheskoy aktivnosti zaderjkoy jidkosti v organizme farmakologiya serdechnoy nedostatochnosti prichini sn ibs: • s sistolicheskoy disfunktsiey (~ 50%) • diastolicheskoy disfunktsiey (~ 10%) drugie prichini i mexanizmi (-15%) arterialnaya gipertenziya: • sistolicheskaya i gipertrofiya miokarda (~ 25%) tseli lecheniya xsn ustranenie simptomov – odishki, otekov, slabosti i dr. umenshenie chisla gospitalizatsiy uluchshenie kachestva jizni zamedlenie progressirovaniya bolezni predotvrashenie klinicheski virajennoy dekompensatsii prodlenie jizni preparati dlya lecheniya xsn (vnok, 2006) osnovnie ix effekt na kliniku, kj i prognoz dokazan i somneniy ne vizivaet iapf bab diuretiki glikozidi ant. aldosterona ara a dopolnitelnie effektivnost i bezopasnost issledovani, no trebuyut utochneniya statini nepryamie antikoagulyanti pri ma v vspomogatelnie vliyanie na prognoz neizvestno, primenenie diktuetsya …

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nim sposobom lecheniya i xsn s soxranennoy sistolicheskoy funktsiey serdtsa (stepen dokazannosti v). ingibitori apf v farmakoterapii xsn “+” effekti ingibitorov apf pri xsn: 1) iapf umenshayut obrazovanie angiotezina ii, aldesterona, katexolaminov i reabsorbtsiyu natriya v pochkax – t.e. umenshayut sosudistoe soprotivlenie, uluchshayut sistolicheskuyu i diastolicheskuyu funktsii jeludochkov, prepyatstvuyut razvitiyu strukturnix izmeneniy v miokarde i sosudax. 2) iapf yavlyayutsya smeshannimi vazodilyatatorami, snijayushimi davlenie napolneniya i sistemnoe soprotivlenie. 3) iapf uvelichivayut obrazovanie kininov, prostaglandinov e2 predserdno natriyureticheskogo faktora, chto privodit k uvelicheniyu pochechnogo krovotoka. 4) iapf prepyatstvuyut remodelirovaniyu serdtsa, a v ryade sluchaev vizivayut obratnoe razvitie gipertrofii miokarda. ingibitori apf s dokazannim i ne dokazannim vliyaniem na zabolevaemost i smertnost pri xsn dokazano iapf, soderjashie sulfgidrilnuyu gruppu kaptopril enalapril lizinopril ramipril trandalapril ne dokazano iapf, soderjashie fosfor fozinopril benazepril moeksipril perindopril kvinapril cd furberg, b. pitt, 2001 iapf, soderjashie dikarboksilnuyu gruppu enalapril prodlevaet jizn i snijaet zabolevaemost u bolnix xsn postgrad …

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bitorov apf pri serdechnoy nedostatochnosti eur heart j 2004;25:1454-1470 preparati i dozi preparati nachalnaya doza tselevaya doza kaptopril 6,25 mg – 3 raza v den 50mg – 3 raza v den enalapril 2,5 mg – 2 raza v den 10-20 mg 2 raza v den lizinopril 2,5-5 mg 1 raz v den 20 mg 1 raz v den ramipril 2,5 mg 1 raz v den 5 mg 2 raza v den ili 10 mg v den trandolapril 1,0 mg 1 raz v den 4 mg 1 raz v den * * antagonisti retseptorov angiotenzina ii v kachestve alternativi iapf pri ix neperenosimosti ili neeffektivnosti mojno ispolzovat ara ii, polnostyu ( v otlichie ot iapf) blokiruyushix effekti raas. “+” effekti ara ii pri xsn: vazodilyatatsiya uvelichenie pochechnogo krovotoka natriyurez snijenie sekretsii aldesterona antiproliferativnoe deystvie antifibroticheskoe deystvie tsitoprotektivnoe deystvie v nastoyashee vremya u bolnix s xsn dokazan polojitelniy effekt trex predstaviteley ara …

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bo. razlichie bilo statisticheski dostoverno (p=0.005). fraktsiya vibrosa u patsientov, poluchavshix valsartan, znachimo uvelichilas ot isxodnogo urovnya do konechnoy tochki po sravneniyu s gruppoy platsebo (p=0.001). primenenie valsartana pri xsn razresheno fda pokazaniya i primenenie diovan pokazan dlya lecheniya xsn (iii-iv klass po nyha) u patsientov s neperenosimostyu iapf. v kontroliruemom klinicheskom issledovanii diovan znachimo snijal chastotu gospitalizatsii v svyazi s xsn. ne polucheno dokazatelstv togo, chto primenenie diovana prinosit dopolnitelnie vigodi pri naznachenii sovmestno s dostatochnoy dozoy iapf. sochetanie diovana s iapf i beta-blokatorami ne rekomenduetsya. * rekomendatsii vnok po lecheniyu xsn, 2006 blokatori retseptorov k angiotenzinu ii po pravu vxodyat v gruppu osnovnix lekarstvennix sredstv dlya lecheniya xsn. v pervuyu ochered eto kasaetsya preparata kandesartan, imeyushego preimushesta v vozmojnosti sovmestnogo naznacheniya s drugimi neyrogormonalnimi mediatorami (uroven dokazatelnosti a, klass rekomendatsiy 1) mogut takje naznachatsya preparati valsartan i lozartan kak alternativa ingibitoram apf pri neperenosimosti poslednix (dokazatelnost v, klass …

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rdtsa (umenshenie gipertrofii miokarda i sokrashenie razmerov polostey serdtsa. 2) normalizatsiya diastolicheskoy funktsii lj 3) umenshenie chss 4) uvelichenie sv (pri dlitelnoy terapii) 5) antiaritmicheskoe i antifibrilyatornoe deystvie, umenshenie elektricheskoy nestabilnosti miokarda 6) umenshenie ishemii i gipoksii miokarda, fibroza miokarda 7) vosstanovlenie jiznesposobnosti kardiomiotsitov i chuvstvitelnosti v-retseptorov k vneshnim stimulam. 8) oposredovannoe umenshenie virajennosti zastoynix yavleniy (cherez blokadu raas). polojitelnoe vliyanie beta-blokatorov proyavlyaetsya v znachitelnom umenshenie riska smertnosti (na 30-35% po sravneniyu s platsebo). krome togo oni polojitelno vliyaet na velichinu serdechnogo vibrosa i nekotorie simptomi xsn. β-adrenoblokatori pri xsn 3 β-blokatora, rekomendovannix dlya naznacheniya bolnim xsn fk spasennie jizni/1000 bolnix v god riska smerti cibis ii bisoprolol iii-iv 132 32% merit-hf metoprolol ii-iv 110 34% sopernicus karvedilol iii-iv 185 35% mesyatsi nablyudeniya % 0 3 6 9 12 15 18 21 20 15 10 5 0 platsebo the merit-hf study group, lancet 1999 betalok zok smertnost p=0.0062 snijenie obshey …

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powerpoint presentation vibor adekvatnogo lecheniya bolnix xsn xronicheskaya serdechnaya nedostatochnost – finalniy etap serdechno-sosudistogo kontinuuma sindrom, razvivayushiysya v rezultate razlichnix zabolevaniy serdechno-sosudistoy sistemi, privodyashix k snijeniyu nasosnoy funktsii serdtsa, giperaktivatsii neyrogrmonalnix sistem i proyavlyayushiysya: odishkoy serdtsebieniem povishennoy utomlyaemostyu ogranicheniem fizicheskoy aktivnosti zaderjkoy jidkosti v organizme farmakologiya serdechnoy nedostatochnosti prichini sn ibs: • s sistolicheskoy disfunktsiey (~ 50%) • diastolicheskoy disfunktsiey (~ 10%) drugie prichini i mexanizmi (-15%) arterialnaya gipertenziya: • sistolicheskaya i gipertrofiya miokarda (~ 25%) tseli lecheniya xsn ustranenie simptomov – odishki, otekov, slabosti i dr...

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