左心衰尽和右心衰尽的症状不同？医生教你分清楚！
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">点击<strong style="color: blue;"><span style="color: black;">蓝字</span></strong>关注<span style="color: black;">咱们</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvgzFb5SxlYVPU3JmX1hIQmzfK6l7hy957KqeUicr0J2v9aawOIa4vryw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><span style="color: black;">心力<span style="color: black;">衰尽</span></span></span></span></strong>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（以下简<span style="color: black;">叫作</span>心衰）是<span style="color: black;">各样</span>心血管事件的<span style="color: black;">最后</span>结果和<span style="color: black;">各样</span>心脏<span style="color: black;">反常</span>的累积效应，<span style="color: black;">最后</span><span style="color: black;">引起</span>心脏泵功能下降。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">做为</span>人体循环的动力泵，心脏的<span style="color: black;">功效</span><span style="color: black;">便是</span>让血液源源<span style="color: black;">持续</span>的流动起来，将血液<span style="color: black;">传送</span>到人体的各个器官。</span></strong>当泵功能下降时，就会<span style="color: black;">显现</span><span style="color: black;">呼气</span>困难、疲乏和液体潴留（肺淤血、体循环淤血及外周水肿）等症状。<span style="color: black;">按照</span>受累的心室不同，心衰<span style="color: black;">病人</span>的<span style="color: black;">重点</span>症状会有所不同。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvVJcGofSPIccetovuJTMn5oEqkriaYccFkqvBdDAum01GvbiaZic8dozyw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">左心<span style="color: black;">衰尽</span>和右心<span style="color: black;">衰尽</span>的症状有何不同？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">左心衰</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">左心衰<span style="color: black;">重点</span>表现为左心排<span style="color: black;">流血</span>量减少和肺淤血。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">左心排<span style="color: black;">流血</span>量减少</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">左心排血量减少</span></strong><span style="color: black;">表现为左心室向前输出的血液<span style="color: black;">不足</span>，心脏排出量不足，器官、组织灌注不足及代偿性心率加快，可<span style="color: black;">引起</span>乏力、疲倦、头昏、心慌等症状；随着外周循环血容量的减少，肾的血流量会<span style="color: black;">显著</span>减少，<span style="color: black;">病人</span>可<span style="color: black;">显现</span>少尿<span style="color: black;">或</span>肾功能的<span style="color: black;">反常</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>向前输出的血液减少，左心室压力会<span style="color: black;">上升</span>，肺循环中血液回流入左心室就会受阻，<span style="color: black;">引起</span><span style="color: black;">肺淤血</span>。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQv9pByuTuaLcM0l2dxibqsJI75ljwBVfB6Y8PbHq80XmgbCVLsazt0oDw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">肺淤血的表现</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不同程度的<span style="color: black;">呼气</span>困难:</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①<strong style="color: blue;"><span style="color: black;">劳力性<span style="color: black;">呼气</span>困难：</span></strong>劳力性<span style="color: black;">呼气</span>困难是左心<span style="color: black;">衰尽</span>最早<span style="color: black;">显现</span>的症状，运动使回心血量<span style="color: black;">增多</span>，左心房压力<span style="color: black;">升高</span>，加重肺淤血。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">②</span><span style="color: black;">夜间阵发性呼吸困难：</span></span><span style="color: black;">病人</span>熟睡后因憋气<span style="color: black;">忽然</span>惊醒，被迫采取坐位，可伴<span style="color: black;">呼气</span>急促，阵咳，咯<span style="color: black;">泡泡</span>样痰，可伴有哮鸣音，又<span style="color: black;">叫作</span>“心源性哮喘”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">③</span><span style="color: black;">端坐<span style="color: black;">呼气</span>：</span></span><span style="color: black;">肺淤血达到<span style="color: black;">必定</span>程度，平卧时回心血量<span style="color: black;">增多</span>且横膈上抬，使<span style="color: black;">呼气</span>更加困难</span><span style="color: black;">，</span><span style="color: black;"><span style="color: black;">病人</span><span style="color: black;">不可</span>平卧</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">④<strong style="color: blue;"><span style="color: black;">急性肺水肿：</span></strong><span style="color: black;"><span style="color: black;">又</span><span style="color: black;"><span style="color: black;">叫作</span></span></span>“心源性哮喘”，是左心衰<span style="color: black;">呼气</span>困难最严重的形式。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">02</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">咳嗽、咳痰和咯血</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">咳痰是肺泡和支气管黏膜充血<span style="color: black;">导致</span>，<span style="color: black;">起始</span>常夜间<span style="color: black;">出现</span>，坐位或立位时减轻，白色浆液性<span style="color: black;">泡泡</span>痰为<span style="color: black;">重点</span>特点，偶可见痰中带血。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvicpiaXPjfHPf4fX3jibL47AHicX9ZfnhYnkqvwLviaftJOnxw54YOY1TpvA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">右心衰</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">右心衰<span style="color: black;">重点</span>表现为右心排<span style="color: black;">流血</span>量减少和体循环静脉淤血。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">右心排血量减少表现</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">右心排血量减少可继发左心功能下降，<span style="color: black;">导致</span>肺循环淤血，<span style="color: black;">导致</span><span style="color: black;">呼气</span>困难。而继发于左心功能不全的右心<span style="color: black;">衰尽</span>，肺循环淤血反而会减轻，<span style="color: black;">呼气</span>困难的症状<span style="color: black;">亦</span>会减轻。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">体循环静脉淤血表现</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">消化道症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>右心衰的<span style="color: black;">病人</span>而言，右心回流血液受阻<span style="color: black;">伴同</span>的体循环静脉压<span style="color: black;">上升</span>，会<span style="color: black;">引起</span>内脏（胃肠道、肝、胆等）瘀血，从而影响消化，诱发食欲不振等症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有<span style="color: black;">有些</span><span style="color: black;">病人</span>可能<span style="color: black;">显现</span>腹胀、恶心呕吐、便秘、腹泻等消化系统症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">02</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">夜尿<span style="color: black;">增加</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">右心衰<span style="color: black;">病人</span>，<span style="color: black;">因为</span>心排血量降低，体循环瘀血，有效循环血量减少，会让肾血流不足，从而<span style="color: black;">引起</span>24小时总尿量减少。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但卧床<span style="color: black;">休憩</span>时，<span style="color: black;">因为</span>回心血量相对<span style="color: black;">增多</span>，心输出量<span style="color: black;">增加</span>，从而<span style="color: black;">导致</span>夜尿<span style="color: black;">增加</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">03</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">水肿</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心源性水肿多从足踝、小腿等<span style="color: black;">起始</span>，还<span style="color: black;">能够</span><span style="color: black;">显现</span>胸水和腹水等。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvD9IicCb30Jadh3G2myc42rPuP7CuUSqqOLtCiblKZW6UPEkDWmsAq14g/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">全心衰在临床上<span style="color: black;">平常</span>吗？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">全心衰是心力<span style="color: black;">衰尽</span>的终末期，<span style="color: black;">上下</span>心<span style="color: black;">同期</span><span style="color: black;">显现</span><span style="color: black;">衰尽</span>表现。</span></strong>临床<span style="color: black;">都数</span><span style="color: black;">状况</span>是右心<span style="color: black;">衰尽</span>继发于左心<span style="color: black;">衰尽</span>而形成全心<span style="color: black;">衰尽</span>，当右心<span style="color: black;">衰尽</span><span style="color: black;">显现</span>之后，右心排血量减少，左心<span style="color: black;">衰尽</span>的<span style="color: black;">呼气</span>困难等肺淤血症状反而有所减轻。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">关于治疗，有什么不<span style="color: black;">同样</span>吗？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">通常</span>治疗</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">上下</span>心衰在治疗病因和诱因、限钠限水、<span style="color: black;">休憩</span>以及适度运动等上是一致的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">药品</span>治疗</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">相<span style="color: black;">针对</span>左心衰，<span style="color: black;">因为</span>大部分右心<span style="color: black;">衰尽</span>继发于左心<span style="color: black;">疾患</span>，尚<span style="color: black;">没</span>针对单纯急性和慢性右心<span style="color: black;">衰尽</span>的<span style="color: black;">药品</span>随机临床<span style="color: black;">实验</span>，缺乏促进右心室功能稳定和恢复的特异性治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>的治疗原则是积极治疗<span style="color: black;">引起</span>右心<span style="color: black;">衰尽</span>的原发<span style="color: black;">疾患</span>，减轻右心前、后负荷，<span style="color: black;">加强</span>心肌收缩力，维持心脏收缩同步性。<span style="color: black;">同期</span>纠正诱发<span style="color: black;">原因</span>，如感染、发热、<span style="color: black;">疲劳</span>、<span style="color: black;">心情</span>激动、妊娠或分娩、<span style="color: black;">长期</span>乘飞机或高原旅行等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvy47ZbDNh8qgtnAnib4XvaBr3ot81nWiaN89TMokjibUAn7Q9hhDZniaA8Q/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">（1）血管扩张剂（硝酸酯类<span style="color: black;">药品</span>和硝普钠）：</span></strong><span style="color: black;">适用于左心收缩和（或）舒张功能不全发展<span style="color: black;">引起</span>的右心<span style="color: black;">衰尽</span><span style="color: black;">病人</span>。<span style="color: black;">针对</span>肺动脉高压<span style="color: black;">引起</span>的右心<span style="color: black;">衰尽</span>，硝酸酯类<span style="color: black;">药品</span>和硝普钠<span style="color: black;">不可</span><span style="color: black;">选取</span>性地扩张肺动脉，反而降低主动脉及外周动脉血压而加重右心缺血、缺氧，<span style="color: black;">增多</span>肺动脉阻力，加剧心衰，应避免<span style="color: black;">运用</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">（2）改善射血分数下降的心衰<span style="color: black;">病人</span>预后的<span style="color: black;">药品</span>：</span></strong>ACEI和β受体阻滞剂能改善右心室功能，但<span style="color: black;">针对</span>动脉性肺动脉高压导致的右心<span style="color: black;">衰尽</span><span style="color: black;">病人</span>，ACEI<span style="color: black;">不可</span><span style="color: black;">增多</span>其运动耐量，<span style="color: black;">也</span><span style="color: black;">不可</span>改善血流动力学，反而可能因动脉血压下降而使病情恶化，β受体阻滞剂<span style="color: black;">也</span>会使动脉性肺动脉高压<span style="color: black;">病人</span>的运动耐量下降和血流动力学不稳定，<span style="color: black;">因此呢</span>需<span style="color: black;">按照</span>右心<span style="color: black;">衰尽</span>的病因<span style="color: black;">恰当</span>用药。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">（3）动脉性肺动脉高压伴发右心<span style="color: black;">衰尽</span>的治疗：</span></strong>利尿剂效果<span style="color: black;">不良</span>的<span style="color: black;">病人</span>，可<span style="color: black;">思虑</span>短期应用正性肌力<span style="color: black;">药品</span>。避免应用非<span style="color: black;">选取</span>性血管扩张剂。特发性肺动脉高压、遗传性和<span style="color: black;">药品</span>毒物<span style="color: black;">关联</span>性肺动脉高压<span style="color: black;">病人</span><span style="color: black;">必须</span>进行急性血管反应<span style="color: black;">实验</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">阳性者可给予大剂量CCB治疗，<span style="color: black;">一般</span>3～4个月后应再次<span style="color: black;">评定</span>。对CCB 反应<span style="color: black;">不良</span>者，应予以<span style="color: black;">选取</span>性的肺血管扩张<span style="color: black;">药品</span>，如内皮素受体拮抗剂、磷酸二酯酶-5<span style="color: black;">控制</span>剂、磷酸鸟苷环化酶激动剂、前列环素类似物及前列环素受体激动剂。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgXZdJOG02NO2NVZkibiaHPEQvTSY2ZlVpHicBgX0UoZP7BD3VczHMibpNGROeT7ceAG2zP2OrpgKym4lw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">审校 | 罗素新</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">【重庆医科大学<span style="color: black;">附庸</span><span style="color: black;">第1</span>医院心血管内科】</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"> 往下看还没完 </span></strong></p>
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