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6257rv7 发表于 2024-5-31 09:56:16

左心衰和右心衰的症状表现有什么不同？

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFhfklBAWvibkGtJia5U3SiaQHNZb72BXfIk2IibLBZDIicBCWapPXJ12eSicg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5Jnx9IqIS2gbMJuGQ4WUrHc9dG7pdpREWXtbic6X66NiaxHrkLIlTLIQ7HWFqEiaIgjwKGYAVCXOVuH8Ig/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">心衰</span></strong><span style="color: black;">指的是</span><span style="color: black;">因为</span>心脏的收缩或（和）舒张功能<span style="color: black;">出现</span><span style="color: black;">阻碍</span>，<span style="color: black;">不可</span>将静脉回心血量排出心脏，<span style="color: black;">引起</span>静脉系统血液淤积、动脉系统血液灌注不足的一组<span style="color: black;">综合症</span>，<strong style="color: blue;"><span style="color: black;"><span style="color: black;">重点</span>表现为<span style="color: black;">呼气</span>困难、体力活动受限和体液潴留。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span><span style="color: black;">出现</span>的<span style="color: black;">能够</span>分为左心衰、右心衰和全心衰。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFMl6EJppFvh9eEyib4W8e1IIH81ANvvgXsIqYbfpzevGZ39tH4MsLr3w/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">左心衰和右心衰的症状有何不同？</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01</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;">以肺淤血和心排血量降低为<span style="color: black;">重点</span>表现，临床上较为<span style="color: black;">平常</span>，症状<span style="color: black;">重点</span>为：</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;">● 从轻到重的<span style="color: black;">呼气</span>困难</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①劳力性<span style="color: black;">呼气</span>困难</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最早<span style="color: black;">显现</span>的症状，多表现于运动后或体力活动后；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②端坐<span style="color: black;">呼气</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">发展到<span style="color: black;">必定</span>程度，<span style="color: black;">病人</span><span style="color: black;">显现</span>“躺不平”，一躺下平卧就<span style="color: black;">呼气</span>困难，坐着<span style="color: black;">才可</span>使症状好转；</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFyPMWHJVcsxUibGnF12XDXf4MogluOHBbws9ymOIeqxASkUsEtOUkM9w/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;"><span style="color: black;">③夜间阵发性<span style="color: black;">呼气</span>困难</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">表现为入睡后<span style="color: black;">忽然</span>因憋气而惊醒，被迫取坐位，坐起后可缓解；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">④急性肺水肿</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">又<span style="color: black;">叫作</span>“心源性哮喘”，表现为<span style="color: black;">呼气</span>困难、端坐<span style="color: black;">呼气</span>、烦躁、窒息感。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFgzL64caQye29TonicttVphQZbRT4KCgKc0P7eyeEANrBribF3npN3cqw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;"><span style="color: black;"><strong style="color: blue;">● 咳嗽、咳痰、咯血</strong></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>肺泡和支气管粘膜淤血，<span style="color: black;">病人</span>会咳出白色浆液性<span style="color: black;">泡泡</span>样痰，急性左心衰时可<span style="color: black;">显现</span>粉红色<span style="color: black;">泡泡</span>样痰。</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;">● 乏力、疲倦、运动耐量减低、<span style="color: black;">头昏</span>、心慌：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>器官、组织灌注不足和代偿性心率加快。</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;">● 少尿及肾功能不全</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心排血量不足时循环血液再分配，肾血流量<span style="color: black;">首要</span>减少。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFdxsYyI57W6JqOwoFwXe6UcYY5RxibiatTIN4RNMwqicYZy8ibaOYDibZFqg/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">02</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">&nbsp;右心衰</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以体循环淤血为<span style="color: black;">重点</span>表现，多<span style="color: black;">因为</span>肺源性心脏病、瓣膜病或右室心肌梗死<span style="color: black;">导致</span>，<span style="color: black;">重点</span>症状为：</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;">● 消化道症状</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃肠道淤血会<span style="color: black;">导致</span>腹胀、纳差、恶心、呕吐等消化道症状。</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;">呼气</span>困难</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>肺部<span style="color: black;">疾患</span>或先天性心脏病<span style="color: black;">引起</span>的右心衰会有<span style="color: black;">呼气</span>困难的表现。</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;">● 右心衰的典型体征是双下肢对<span style="color: black;">叫作</span>性凹陷性水肿。</span></strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFAP5Zl0ibuEQsE2p3nYBITibjibLrSmx2wsO2ZbicJrZLxrFuicYObYAGjLg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">03</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">&nbsp;全心衰</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">见于心脏病晚期，在临床上不少见，<span style="color: black;">重点</span>是<span style="color: black;">因为</span><strong style="color: blue;"><span style="color: black;">左心衰的肺循环压力过大逆传至右心室，</span></strong><span style="color: black;">这般</span>的<span style="color: black;">状况</span><span style="color: black;">常常</span>会减轻之前的肺淤血症状。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有一种<span style="color: black;">平常</span>病因是<strong style="color: blue;"><span style="color: black;">扩张型心肌病，</span></strong><span style="color: black;">同期</span><span style="color: black;">显现</span>左、右心脏<span style="color: black;">衰尽</span>，肺淤血症状<span style="color: black;">常常</span>不严重，<span style="color: black;">重点</span>表现为左心衰心排血量减少的<span style="color: black;">关联</span>症状和体征。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFsFSib5j54yibjQibibYYH8MES5xxjdGOzPcJgCoOHBNWU15GFjhtdXzMSA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">左心衰和右心衰的治疗</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在<span style="color: black;">通常</span>治疗上，两者大致是<span style="color: black;">同样</span>的，<strong style="color: blue;"><span style="color: black;">要限钠限水，急性期要限制体力活动以减轻心脏负荷，稳<span style="color: black;">定时</span>病人应主动进行有氧运动。</span></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;">● 左心衰常用<span style="color: black;">药品</span>治疗</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①利尿药</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">用于<span style="color: black;">掌控</span>体液潴留，<span style="color: black;">运用</span>袢利尿剂（呋塞米）时要监测血钾，防止低血钾；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">运用</span>噻嗪类可能<span style="color: black;">导致</span>高尿酸血症；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有保钾利尿剂，它<span style="color: black;">通常</span>是与<span style="color: black;">以上</span>两种药的其中一种联合<span style="color: black;">运用</span>。<span style="color: black;">吃下</span>利尿剂，要<span style="color: black;">定时</span>检测肾功能、电解质等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②RAAS<span style="color: black;">控制</span>剂</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">ACEI、ARB、ARNI等可改善心脏重构、降血压减轻后负荷，ARNI<span style="color: black;">日前</span>在临床上用的最多，<span style="color: black;">吃下</span>时要监测血压、肾功能、电解质等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">③β受体阻滞剂</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可<span style="color: black;">控制</span>交感神经激活对心力<span style="color: black;">衰尽</span>代偿的<span style="color: black;">有害</span><span style="color: black;">功效</span>。支气管痉挛性<span style="color: black;">疾患</span>、严重心动过缓、二度及以上房室传导阻滞、严重<span style="color: black;">周边</span>血管<span style="color: black;">疾患</span>和重度急性心衰病人禁用，<span style="color: black;">吃下</span>时要监测心率、血压，<span style="color: black;">定时</span>复查动态心电图。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFNwTGxNicngne5EKNmGg5Z63RHk4kXX9o7e9t5Nb5IlsAc7W5ADTIkiaw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;"><span style="color: black;">④正性肌力药</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">洋地黄类<span style="color: black;">药品</span>的治疗窗比较窄，应用中要<span style="color: black;">重视</span>血药浓度监测，防止<span style="color: black;">显现</span>洋地黄中毒，中毒表现<span style="color: black;">重点</span>为各类<span style="color: black;">心率</span>失常，以室性<span style="color: black;">心率</span>失常<span style="color: black;">平常</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">⑤伊伐布雷定</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可减慢窦性<span style="color: black;">心率</span>，延长舒张期，改善左心室功能及生活质量。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">⑥扩血管<span style="color: black;">药品</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性心衰不<span style="color: black;">举荐</span><span style="color: black;">运用</span>，若伴有心绞痛或高血压的<span style="color: black;">病人</span>可<span style="color: black;">思虑</span><span style="color: black;">运用</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性心衰<span style="color: black;">病人</span>可用于降低后负荷。</p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFibSMNLo8wADZQ0iayjmY51kclpHNm58qjegvF2BUEqdzBgBnZ4kJRBicQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">● 右心衰常用<span style="color: black;">药品</span>治疗</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性右心衰治疗最<span style="color: black;">要紧</span>的是容量管理，<span style="color: black;">因此呢</span>右心<span style="color: black;">衰尽</span>的<span style="color: black;">病人</span>更要<span style="color: black;">重视</span><span style="color: black;">掌控</span>出入水量，监测水肿<span style="color: black;">状况</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①&nbsp;利尿剂</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">独一</span>能够充分<span style="color: black;">掌控</span>右心<span style="color: black;">衰尽</span>液体潴留的<span style="color: black;">药品</span>，有效降低前负荷，为<span style="color: black;">快速</span>缓解症状的首选<span style="color: black;">药品</span>，<span style="color: black;">长时间</span><span style="color: black;">吃下</span>要监测肾功能、电解质等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②&nbsp;血管活性<span style="color: black;">药品</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在急性右心<span style="color: black;">衰尽</span>的治疗中<span style="color: black;">拥有</span><span style="color: black;">要紧</span><span style="color: black;">功效</span>，目的在于降低右心室后负荷，<span style="color: black;">增多</span>前向血流和右心室灌注。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFww8fG3npI9FFwyvUZyKTX7ZiapVRC4XvT7Q7Vib1YvJcEbO4tqNicflhA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;"><span style="color: black;">③&nbsp;ACEI和β受体阻滞剂</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">能改善右心室功能，但<span style="color: black;">针对</span>动脉性肺动脉高压<span style="color: black;">引起</span>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。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">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，医生会<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，而<span style="color: black;">吃下</span>者需监测血压、心率、肺动脉压力等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">④&nbsp;正性肌力药</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">动脉性肺动脉高压伴发右心<span style="color: black;">衰尽</span><span style="color: black;">病人</span>若<span style="color: black;">运用</span>利尿剂效果<span style="color: black;">不良</span>的话，可<span style="color: black;">思虑</span>短暂<span style="color: black;">运用</span>正性肌力药。</p><img src="https://mmbiz.qpic.cn/mmbiz_png/aq5KM8M5JnwF7Krib1tQwiaZETUYZUhKpFyVc6d5FW1lwMNGChIFEeAEmP0az391Hahraf82vpTlHfKITyiaoWibrQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">除<span style="color: black;">药品</span>治疗外，<strong style="color: blue;"><span style="color: black;">心衰还有心脏再同步化治疗（CRT）、<span style="color: black;">移植</span>型<span style="color: black;">心率</span>转复除颤器（ICD）、左室辅助<span style="color: black;">安装</span>（LVAD）、心脏移植等治疗，</span></strong><span style="color: black;">按照</span>病情不同<span style="color: black;">选取</span>不同治疗<span style="color: black;">方法</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左心衰和右心衰的病因、临床表现和治疗<span style="color: black;">办法</span>略有不同，<strong style="color: blue;"><span style="color: black;"><span style="color: black;">倘若</span>自我<span style="color: black;">评定</span>下来，有<span style="color: black;">基本</span><span style="color: black;">疾患</span>和相应症状，要<span style="color: black;">即时</span>就诊，<span style="color: black;">才可</span><span style="color: black;">恰当</span>用药、有效治疗！</span></strong></p>
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akbchina.cn 发表于 2024-8-29 05:44:16

我完全同意你的观点，说得太对了。

wrjc1hod 发表于 2024-10-10 08:47:25

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m5k1umn 发表于 2024-10-10 19:28:21

我完全同意你的看法，期待我们能深入探讨这个问题。

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