摘要
目前我国心力衰竭(心衰)防控形势严峻。令人欣慰的是,近年来心衰治疗领域取得了诸多进展。在药物治疗方面,血管紧张素受体脑啡肽酶抑制剂的循证医学证据日益增多,非奈利酮可改善射血分数保留的心衰患者的预后,钠-葡萄糖共转运蛋白2抑制剂适用于不同射血分数类型心衰患者的治疗,胰高血糖素样肽-1受体激动剂对肥胖和射血分数保留的心衰患者有益,可溶性鸟苷酸环化酶刺激剂维利西呱可改善射血分数降低的心衰患者的预后,中药芪苈强心胶囊被证实可降低射血分数降低的心衰患者的心血管死亡或心衰恶化风险。利尿剂是容量管理的基础治疗手段,针对利尿剂抵抗也有了更多应对策略。在非药物治疗方面,心脏植入型电子器械治疗和心脏瓣膜病介入治疗等为不同类型和阶段的心衰患者提供了更多选择。遵循指南规范防治才能使上述治疗真正惠及心衰患者,而全科医师可在其中发挥重要作用,包括对心衰高危人群的早期筛查与干预,对慢性心衰患者进行长期随访,以及合并症的管理等。
The prevention and control of heart failure(HF)remains challenging in China.Encouragingly,significant therapeutic advancements have emerged in recent years.In pharmacotherapy,angiotensin receptor neprilysin inhibitors(ARNIs)are supported by growing evidence,while finerenone improves outcomes in patients with heart failure with preserved ejection fraction(HFpEF).Sodium-glucose co-transporter 2(SGLT2)inhibitors are applicable across all HF subtypes,and glucagon-like peptide-1 receptor agonists(GLP-1 RAs)benefit obese patients with HFpEF.Vericiguat,a soluble guanylate cyclase stimulator,improves prognosis in patients with heart failure with reduced ejection fraction(HFrEF).The traditional Chinese medicine Qili Qiangxin Capsule has been shown to reduce cardiovascular death or HF exacerbation in HFrEF patients.Diuretics remain foundational for congestion relief,with improved strategies addressing diuretic resistance.Non-pharmacological interventions,such as cardiac implantable electronic devices(CIEDs)and transcatheter valve therapies,expand options for diverse HF stages.Adherence to guideline-directed management is critical to translating these advancements into patient benefits.General practitioners play a pivotal role in early screening of high-risk populations,long-term follow-up of chronic HF patients,and coordinated management of comorbidities,ultimately reducing disease burden and improving outcomes of HF patients.
作者
柴坷
王华
Chai Ke;Wang Hua(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华全科医师杂志》
2025年第7期769-777,共9页
Chinese Journal of General Practitioners
基金
国家科技创新2030“四大慢病”重大专项(2023ZD0504600)
首都卫生发展科研专项(首发2022-1-4052)
中央高水平医院临床科研业务费(BJYY-2023-070)
中国医学科学院创新工程(2021-I2M-1-050)。
关键词
心力衰竭
治疗
综合预防
管理
全科医师
Heart failure
Therapeutic
Universal prevention
Management
General practitioner
