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各位朋友，大家好，现在是“每天健康三分钟”时间，我是道简-心血管康复集团的护士侯思家，今天有我来给大家讲讲心脏康复五大处方中的药物处方。
心脏康复首先就是规范合理的使用药物，国内外冠心病指南-致强调，改善冠心病患者预后的重要措施是充分使用有循证证据的二级预防药物
如：阿司匹林、氯吡格雷、他汀、ACEI、β受体阻滞剂,出院后遵医嘱应长期坚持使用。
他汀对肝功能的影响很小，不要过于担心，常用他汀类药物包括阿托伐他汀、瑞舒伐他汀、普伐他汀、辛伐他汀等。服用他汀类药物1~2个月复查肝功能、肌酶和血脂，以后可以6个月复查-次，长期坚持服用他汀类药物在二级预防中的重要性
受体阻滞剂作用主要缘于抑制交感神经张力和降低儿茶酚氨本身心*毒脏**性作用两方面。自20世纪60年代以来,它已广泛应用于心力衰竭(心衰)高血压、冠心病、心失常等心脏疾病的康复治疗。对于冠心病患者,它可降低心肌收缩力、降低血压和心率,从而降低心肌耗氧量和心绞痛的发作;是唯一兼有改善症状和改善预后作用的药物。因此,指南推荐冠心病患者康复过程中,如无禁忌证均应尽量使用β受体阻滞剂。大量研究证实,β受体阻滞剂用于心衰患者可长期改善心功能、延缓心衰进展、降低病死率;但是β受体阻滞剂还具有负性肌力作用,心衰患者如果应用时机剂量不当,也可加重病情。临床应用的总体原则是:待心衰病情稳定、无液体潴留时,从小剂量开始应用，酌情逐渐加量,达到长期维持。低血压、心动过缓和支气管哮喘等患者不宜应用。目前临床常用的β受体阻滞剂药物有比索洛尔、卡维地洛和缓释美托洛尔等。
双联抗血小板药物联合应用1年对避免支架内血栓发生非常重要，1年后仍应终 身坚持服用- -种抗血小板药物,以避免再发心血管事件，并观察胃肠道不良反应。
患者晨起静息心率在55~60次/分,是提示服用β受体阻滞剂的剂量达到了治疗效果，不应减量，应坚持服用。
对于心血管病患者药物调整是个长期的动态过程，心血管病患者如果想拥有比较好的生活质量，降低再发病率、再住院率，要接受自己必须长期规范进行药物治疗的现实，并且在医生指导下进行心脏康复，定期与医生沟通，进行药物调整。
患者出院后1、3、6、9、12个月应该进行门诊随诊，检查血脂、血压、血糖是否达标。
最后祝大家生活愉快，身体健康！想了解更多心血管科普小知识，请关注我们，咱们下期见。
【英文版】
drug prescription, one of the five prescriptions for cardiac rehabilitation
Dear friends, nice to meet you!Now it is time for “health talk for three minutes every day”,My name is Hou Sijia, a nurse of Daojian Doctor Group of Cardiovascular Rehabilitation.Today, I'd like to tell you about one of the five prescriptions for cardiac rehabilitation, drug prescription.
First of all, cardiac rehabilitation is to standardize and rational use of drugs. Domestic and foreign guidelines for coronary heart disease unanimously emphasize that the important measure to improve the prognosis of patients with coronary heart disease is to make full use of secondary prevention drugs with evidence-based medical evidence,such as aspirin, clopidogrel, statins, ACEI, beta blockers, and they should follow the doctor's advice and insist on taking drugs for a long time after discharge.
Statins have little effect on liver function, so don't worry too much about its side effects. Commonly used statins include atorvastatin, rosuvastatin, pravastatin, simvastatin and so on. After taking statins for 1-2 months, the liver function, muscle enzyme and blood lipid can be reviewed once,and then the above indexes can be reviewed every 6 months. Long term use of statins plays an important role in secondary prevention of cardiovascular disease.
The effects of β - blockers mainly include inhibition of sympathetic tone and reduction of cardiotoxicity of catechol ammonia itself.Since the 1960s, it has been widely used in the rehabilitation of heart diseases such as heart failure, hypertension, coronary heart disease, arrhythmia and so on. For patients with coronary heart disease, it can reduce myocardial contractility, blood pressure and heart rate, reduce myocardial oxygen consumption, thus reducing the attack of angina pectoris.β - blockers are the only drugs that can improve the symptoms and prognosis of patients. Therefore, the guidelines recommend that patients with coronary heart disease should take β - blockers in the rehabilitation process if there is no contraindication.
A large number of studies have confirmed that β - blockers can improve heart function, delay the progression of heart failure and reduce mortality in patients with heart failure for a long time. However, β - blockers also have a negative inotropic effect,which can aggravate the condition of heart failure patients if the dosage is improper. The general principle of clinical application of β - blockers is that patients with heart failure need to maintain stable symptoms and ensure that patients do not have fluid retention, β-blockers can be applied at a small dose, and the dose should be gradually increased, and eventually maintained at a sustained dose. β-blockers couldn’t be used in patients with hypotension, bradycardia, bronchial asthma. At present, bisoprolol, carvedilol and sustained-release metoprolol are commonly used β - blockers in clinic.
It is very important to avoid the occurrence of stent thrombosis by using dual antiplatelet drugs for one year. After one year, we should still take antiplatelet drugs for life to avoid recurrence of cardiovascular events and observe gastrointestinal adverse reactions. The resting heart rate in the morning is 55-60 beats / min, which indicates that the dosage of β - blocker has reached the therapeutic effect. It should not be reduced but should be taken persistently.
Cardiovascular adjustment is a long-term dynamic process.If patients want to have better quality of life, reduce the incidence rate of recurrence rate and re hospitalization rate,they must accept the reality that they must have long-term standardized medication, and carry out cardiac rehabilitation under the guidance of doctors, communicate with doctors regularly, and make drug adjustments.Outpatients should be followed up at first, third, ninth and twelfth months after discharge to check whether the blood lipid, blood pressure and blood glucose are up to standard.
Finally, I wish you all a happy life and good health!To learn more about cardiovascular disease, please pay attention to us. See you next time.