药理学 第20章治疗充血性心力衰竭的药物.ppt

文档介绍：第二十章抗慢性心功能不全药
充血性心力衰竭(congestive heart failure, CHF)是指在适当的静脉回流下,心脏排出量绝对或相对减少,不能满足机体、组织所需的一种病理状态,同时它又是一种超负荷心脏病(cardiomyopathy of overload), 此时,心肌的收缩功能和/或舒张功能下降,最终导致体循环和/或肺循环淤血,成为CHF。
慢性心功能不全的主要病理学基础是
心排出量不足
原发性心肌舒缩功能障碍
心脏负荷过度
前负荷(容量负荷)
后负荷(压力负荷)
主要原因:
①心肌病变心肌炎、心肌缺血或梗塞、心肌代
谢紊乱(VitB1缺乏)等,使心肌代谢失常,
收缩功能减退。
②心脏负荷加重高血压、主A瓣狭窄、二尖瓣
关闭不全,肺动脉狭窄、肺A高压
甲亢:机体代谢,而对CO需求
严重贫血:血液携O2,对CO需求
Symptoms of Heart Failure
Congestive heart failure (CHF) symptoms that result from the pooling of blood include shortness of breath, edema (fluid retention), and swelling of the legs and feet. CHF symptoms that result from the inefficiency of the heart to distribute or adequately pump oxygen-rich blood to body tissues include fatigue and weakness, as well as loss of appetite. As CHF progresses, these symptoms can severely impact the patient’s quality of life, so that even the ability to perform simple tasks,
such as walking across a room, es limited.
治疗CHF的常用药物
正性肌力药物
减负荷药物
第一节强心苷 Cardiac Glycosides
O
O
OH
CH3
CH3
H
O
C18 H31O9
12
A
C
B
D
17
3
3分子洋地黄毒糖
Sugars- 3 mols. of digitoxose
苷元
Aglycones
不饱和内酯环
Unsaturated lactone
甾核
steroid nucleus