close
只需要了解這三大 Mechanism :
1. Preload
2. Afterload
3. LV function
顧好降 Preload + 降 Afterload 就可解決大部分病患
增加 LV contractility 的升壓藥 也會影響 Afterload
只用在血壓低的病人
For Prelaod ~~
Furosemide :
Amal : 腎臟灌流已經不足, 給 Furosemide 意義也不大, 甚至一開始降低 CO, 增加 Afterload
一開始反而讓狀況更糟, 要有作用要等到 60 mins 後才真的 diuresis
要先給 Catopril 降低 Afterload 讓 kidney 有 perfusion 再給 diuresis 才更好 (Immediated and sustained decrease PCWP)
Amal 小結論 :
Furosemide should be considered 3rd line medication for cardiogenic pulmonary edema !
NTG :
Reliable preload reducer
Moderate to high dose reduce afterload
Short half life
Caution : Hypotension, acute MR, AS, pHTN, with Viagra
Amal 小結論 : NTG should be considered 1st line medication for moderate HF or cardiogenic pulmonary edema !
For Afterload ~~
Moderate to high dose NTG reduce afterload
ACEI 也好用, Catopril SL 能快速降 Afterload
Bolus NTG (2mg Q3-5mins) is safe and effective !
所以 High dose NTG 一次解決 Preload + Afterload
Amal 小結論 : High dose NTG or ACEIs should be considered 2nd line medication
for moderate HF or cardiogenic pulmonary edema !
Inotropic 升壓藥部分目前沒有什麼好實證, Norepi or dopa 隨意
文章標籤
全站熱搜
留言列表
CV (7)
