慢性心衰治疗的基本理念:过去、现在和未来

Basic concept of treatment for chronic heart failure: past, present and future

上世纪70年代,慢性心力衰竭(心衰)的治疗主要采用强心、利尿和扩血管药物,以改善患者的血流动力学状态,但病死率未见显著降低。上世纪80年代末以来,研究证实肾素-血管紧张素-醛固酮系统和交感神经系统过度激活在心衰发生发展的病理生理学机制中发挥了极其重要的作用,阻断这两个系统的药物可显著降低心衰患者的病死率,从而成为心衰治疗的基石。2010年以来,3种不同类型的新药——伊伐布雷定、LCZ696和中药芪苈强心胶囊对心衰的疗效得到肯定,预示心衰治疗的理念又有了新的改变,未来心衰治疗新理念是:神经内分泌阻滞/调节与整体调控相结合。

In the 70s of last century, the treatment of chronic heart failure (CHF) mainly uses inotropic drugs, diuretic and vasodilators, which can improve the hemodynamic condition and have no change in mortality in patients. Since the end of 1980s, excessive activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system have demonstrated to play a key role in the pathophysiology of CHF. Blockade of these two systems can significantly reduce the mortality of CHF, which become a comerstone of the treatment of heart failure. Since 2010, three different types of drugs namely ivabradine, LCZ696 and a kind of traditional Chinese medicine have been shown confirmed the curative effects for heart failure, that means a new concept of CHF treatment, neurohormonal blockade/inducing and systematical regulation.