基于2021 ESC指南对儿童急慢性心力衰竭药物治疗述评

Review for pharmacologic treatment of acute and chronic heart failure in children based on the 2021 ESC guideline

儿童心力衰竭(HF)发病率高,是很多心脏或非心脏疾病的终末状态,也是儿科最常见的急危重症之一。由于心脏移植和器械治疗在儿童这个特殊群体使用受限,因此儿童HF的药物治疗就显得更为重要。但由于在儿童开展药物前瞻性临床试验存在重大障碍,使得大多数对儿童HF药物治疗的推荐都是从成人研究中延伸出来。2021年8月欧洲心脏病协会(ESC)发布了新版的《心力衰竭诊断与治疗指南》,提出了成人HF治疗中较多的新的药物治疗改变。故本文结合临床实践、新近发布的循证医学证据以及新指南,评述儿童HF已经使用或即将可能使用的新药,以期为儿童HF的治疗提供参考。

Heart failure(HF)has a high incidence in children and is the end state of many cardiac or non-cardiac diseases.Because heart transplantation and device therapy are more limited in this special group of children,medical treatment of heart failure in children is even more important.However,due to significant barriers to conducting prospective clinical trials of drugs in children,most recommendations for drug therapy in children with HF have been extended from studies in adults.In August 2021,the European Society of Cardiology(ESC)released a new version of the Guidelines for the Diagnosis and Treatment of Heart Failure,proposing many new changes in the treatment of adult heart failure.Therefore,this article combines clinical practice,newly released evidence-based medical evidence and new guidelines to look forward to recent and upcoming new drugs used in children with HF,in order to provide a reference for the treatment of pediatric heart failure.