心衰竭藥物治療原則與藥事照護

Pharmacotherapy Principles and Pharmaceutical Care in Heart Failure

心衰竭為各種心血管疾病之最終共同症候群，導致心輸出量不足以供應身體各器官組織的需求。其病因複雜，病程冗長，復發頻仍。對應之治療策略包括藥物、經皮冠狀動脈介入性治療或外科手術、機械性輔助裝置，甚至是心臟移植。不同模式間之共通考量點為著重「疾病照護」之全面評估，而非採取「頭痛醫頭、腳痛醫腳」之單一問題處置。適當的藥物治療對心衰竭病人可緩解症狀、減少住院頻次，降低死亡機率。另一方面，由於心衰竭涉及多重器官系統功能低下，又併用多種治療策略，對於藥物動力學及藥效學之變化，更需嚴密監控。本文針對心衰竭之藥物治療及藥事照護如何緩解病因、考量共病、優化療程三大面向，加以論述。

"Heart failure (HF) is the final common pathway of various cardiovascular diseases, leading to insufficient perfusion to vital organ systems. It is characterized by the heterogenous in etiology, complicated clinical course, and high frequency of recurrence. Corresponding therapeutic strategies include pharmacotherapy, percutaneous coronary intervention or surgery, mechanical assist devices, or even heart transplantation. The critical consideration is the comprehensiveness of disease management rather than piecemeal approach. Appropriate pharmacotherapy to HF patients can alleviate symptoms, reduce hospitalization, and improve survival. On the other hand, the multi-organ dysfunction and interrelated treatment modalities in HF patients urge the requirement of close monitor on pharmacokinetics and pharmacodynamics. This article addresses three pivotal issues about pharmacotherapy for patients with HF: resolving the etiology, consideration about comorbidities, and optimizing the treatment course."