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在心力衰竭多药物治疗的现实情况下,有必要探讨各种阻断肾素-血管紧张素-醛固酮系统药物的使用时机及联合使用问题,近期的CHARM试验提供了许多有价值的信息。尽管在心力衰竭总人群中具有β2、α受体阻滞作用的β受体阻滞剂是否更有改善生存率的优势仍在继续争论,但在包含了不同临床特点的亚组人群中应注意不同β-阻滞剂间的差异。现阶段如何进一步改善心力衰竭预后是一个非常具有挑战性的现实课题,根据病人临床特点实施个体化治疗,调整使用药物的传统顺序与组合,或者采用双室起搏等非药物的方法,是目前具有可行性的解决方案。
In the realities of multi-drug treatment of heart failure, it is necessary to explore various timing and combined use of drugs that block the renin-angiotensin-aldosterone system, and the recent CHARM test provides many valuable information. Although the benefits of β blockers with β2, α blockade in improving overall survival in the general population of people with heart failure are still debating whether to improve survival, care should be taken in subgroups of patients with different clinical characteristics Differences between different β-blockers. How to further improve the prognosis of heart failure at this stage is a very challenging practical issue. It is the current practice to implement individualized treatment according to the clinical characteristics of patients, to adjust the traditional order and combination of using drugs, or to adopt non-drug methods such as biventricular pacing. Feasible solution.