β受体阻滞剂在PCI中的应用.pptx

β受体阻滞剂在PCI术的应用
提纲
◆β受体阻滞剂药理
◆心率增快增加冠心病患者的临床事件
◆β受体阻滞剂在PCI围手术期的应用
药理学及作用机制
主要机制:对抗儿茶酚***类肾上腺素能递质毒性尤其是通过β1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:


,抑制肾素-AngII-醛固***系统。
:

:抑制β肾上腺素能通路介导的心肌细胞凋亡、抑制血小板聚集、减少对粥样硬化斑块的机械应激、防止斑块破裂等。
心率增快增加冠心病患者的风险!
The effect of heart rate on local haemodynamic forces on the endothelium.
Mechanisms whereby an elevated heart rate leads to adverse es in patients with coronary artery disease.
β阻滞剂在急性心肌梗死的应用
Setting/indication
Class
Level
. 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
β阻滞剂在慢性稳定性心绞痛的应用
Expert consensus document on β-adrenergic receptor blockers. European Heart Journal .2004, 25: 1341–1362.
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
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 e 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的风险明显增高!
β阻滞剂在心肌梗塞后二级预防的应用
Setting/indication
Class
Level
All patients without contraindications, indefinitely
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