β受体阻滞剂应用.ppt

Expert consensus document on b adrenergic receptor blockers The Task Force on Beta-Blockers of the European Society of Cardiology European Heart Journal (2004)25, 1341-1362  Classes of Recommendations Class I: Evidence and/or general agreement that a given procedure/treatment is beneficial, useful and effective Class ll: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the procedure/treatment Class lla: Weight of evidence/opinion is in favour of usefulness/efficacy Class llb: Usefulness/efficacy is less well established by evidence/opinion Class l: Evidence or general agreement that the treatment is not useful/effective and in some cases may be harmfu  Levels of Evidence Level of Evidence A: Data derived from multiple randomised clinical trials or metaanalyses Level of evidence B: Data derived from a single randomised clinical trial or nonrandomised studies Level of Evidence C: Consensus of opinion of the experts and/or small studies  Introduction B-Blocker therapy plays a major role in the treatment of cardiovascular diseases antiischaemic a antiarryhthmi antihypertensive heart failure  Pharmacokinetic properties There are important pharmacokinetic differences among B-blockers  Effects mediated by阝1and阝2 adrenoceptors Tissue Effect SA nodes. Increase in heart rate AV node Increase in conduction velocity Increase in contractility Ventricles Increase in contractility, conduction velocity and automaticity of idioventricular pacemakers Arteries Vasodilation Skeletal muscle Vasodilation, increased contractility Glycogenolysis, K+uptake Glycogenolysis and gluconeogenesis Pancreas(βcel) Insulin and glucagon secretion at cells Lipolysis Kidney Renin release Gallbladder and ducts Relaxation Uterus Relaxation Nerve terminals Promotes noradrenaline release Parathyroid glands P2 Parathormone secretion 6  Classification of B-blockers B-Blockers can be broadly classified int