问题23：左心衰VS右心衰的处理
<span style="color: black;">心力<span style="color: black;">衰尽</span>( heart failure)指在静脉回流<span style="color: black;">没</span>器质性<span style="color: black;">阻碍</span>的<span style="color: black;">状况</span>下,<span style="color: black;">一般</span>是<span style="color: black;">因为</span>心肌收缩力下降<span style="color: black;">导致</span>心排血量减少,<span style="color: black;">不可</span>满足机体代谢<span style="color: black;">必须</span>的一种<span style="color: black;">综合症</span>。临床上以肺和(或)体循环淤血以及组织灌注不足为特征,又<span style="color: black;">叫作</span>充血性心力<span style="color: black;">衰尽</span>( congestive heart failure)。</span><span style="color: black;">心力<span style="color: black;">衰尽</span>的病因<span style="color: black;">非常多</span>,可分为心肌本身病变和心室负荷过重两大类,前者如心肌缺血、心肌坏死或心肌炎症;后者又可分为阻力负荷过重(如高血压、主动脉瓣狭窄等)和容量负荷过重(如二尖瓣或主动脉瓣关闭不全等)。心力<span style="color: black;">衰尽</span>的<span style="color: black;">出现</span>除基本病因外,常有诱发<span style="color: black;">原因</span><span style="color: black;">促进</span>其发病或使其在原有<span style="color: black;">基本</span>上病情加重,如感染、<span style="color: black;">心率</span>失常、钠盐摄入<span style="color: black;">太多</span>、输液<span style="color: black;">太多</span>和(或)过快、以及过度<span style="color: black;">疲劳</span>等<span style="color: black;">增多</span>心脏负荷的多种<span style="color: black;">原因</span>。</span><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">类型：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">左心<span style="color: black;">衰尽</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">右心<span style="color: black;">衰尽</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">全心<span style="color: black;">衰尽</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性心衰（左心衰多见）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性心衰</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">收缩性心衰</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">舒张性心衰</span></p><span style="color: black;">利尿→扩管→强心</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性左心衰</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性右心衰</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左心<span style="color: black;">衰尽</span>（肺淤血）乏力,进行性劳力性<span style="color: black;">呼气</span>困难、夜间阵发性<span style="color: black;">呼气</span>困难、端坐<span style="color: black;">呼气</span>,咳嗽、<span style="color: black;">泡泡</span>痰,<span style="color: black;">少许</span><span style="color: black;">显现</span>咯血。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">右心<span style="color: black;">衰尽</span>（体循环淤血)腹胀、少尿及食欲不振,<span style="color: black;">乃至</span>恶心呕吐。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">体征</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.左心<span style="color: black;">衰尽</span><span style="color: black;">重点</span>为肺淤血的体征。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1）视诊:有不同程度的<span style="color: black;">呼气</span>急促、轻微发绀,高枕卧位或端坐体位。急性肺水肿时可<span style="color: black;">显现</span>自口、鼻涌出<span style="color: black;">海量</span>粉红色<span style="color: black;">泡泡</span>,<span style="color: black;">呼气</span>窘迫,并大汗淋漓。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2）触诊:严重者可<span style="color: black;">显现</span>交替脉。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(3）叩诊:除原发性心脏病体征外,<span style="color: black;">一般</span><span style="color: black;">没</span>特殊<span style="color: black;">发掘</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4）听诊:心率增快,心尖区及其内侧可闻及舒张期奔马律,P2亢进。<span style="color: black;">按照</span>心力<span style="color: black;">衰尽</span>程度的轻重,单侧或双侧肺可闻及由肺底往上的不同程度的细小湿啰音,<span style="color: black;">亦</span>可伴少量哮鸣音;急性肺水肿时,则双肺满布湿啰音和哮鸣音。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.右心<span style="color: black;">衰尽</span><span style="color: black;">重点</span>是体循环系统淤血的体征。(1）视诊;颈静脉怒张,可有<span style="color: black;">周边</span>性发绀,水肿。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2）触诊:可触及不同程度的肝肿大、压痛及肝颈静脉回流征阳性。下肢或腰骶部等下垂部位凹陷性水肿,严重者可全身水肿。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">( 3）叩诊:可有胸腔积液(右侧多见)与腹腔积液体征。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4)听诊:<span style="color: black;">因为</span>右心室扩大可在三尖瓣区闻及三尖瓣相对关闭不全的收缩期吹风样杂音,以及右心室舒张期奔马律。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">除以上所列体征外,尚有原发性心脏病变和心力<span style="color: black;">衰尽</span>诱因的症状与体征</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">舒张期心衰的治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">舒张不良→肺淤血</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肥厚性心肌病、高血压、冠心病</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">办法</span>：降低肺静脉压、β（-）、心率50-60bpm、Ca（-）、ACEI/ARB</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">超链接:</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">怎样</span>做好心衰的<span style="color: black;">病人</span>的容量管理？</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">【<span style="color: black;">举荐</span>精彩课件】心衰<span style="color: black;">病人</span>的<span style="color: black;">麻木</span>处理例(可下载)</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">麻木</span><span style="color: black;">大夫</span>眼中的心衰</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">心衰<span style="color: black;">病人</span>围术期管理</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">【Anesthesia Headline】慢性</a>心衰<span style="color: black;">病人</span>的手术<span style="color: black;">危害</span>和<span style="color: black;">麻木</span>管理</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【类型】</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(一）左心<span style="color: black;">衰尽</span>、右心<span style="color: black;">衰尽</span>和全心<span style="color: black;">衰尽</span></span></p><span style="color: black;">左心<span style="color: black;">衰尽</span>由左心室代偿功能不全<span style="color: black;">导致</span>,以肺循环淤血为特征,临床上较为<span style="color: black;">平常</span>。单纯的右心<span style="color: black;">衰尽</span><span style="color: black;">重点</span>见于肺源性心脏病及某些先天性心脏病,以体循环淤血为<span style="color: black;">重点</span>表现。左心<span style="color: black;">衰尽</span>后肺动脉压力<span style="color: black;">升高</span>,使右心负荷加重,右心<span style="color: black;">衰尽</span>继之<span style="color: black;">显现</span>,即为全心<span style="color: black;">衰尽</span>。心肌炎、心肌病病人左、右心<span style="color: black;">同期</span>受损,左、右心衰可<span style="color: black;">同期</span><span style="color: black;">显现</span>而表现为全心<span style="color: black;">衰尽</span>。</span><span style="color: black;">单纯二尖瓣狭窄<span style="color: black;">导致</span>的是一种特殊类型的心衰,不<span style="color: black;">触及</span>左心室的收缩功能,而直接因左心房压力<span style="color: black;">上升</span>而<span style="color: black;">引起</span>肺循环高压,有<span style="color: black;">显著</span>的肺淤血和相继<span style="color: black;">显现</span>的右心功能不全。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(二）急性和慢性心力<span style="color: black;">衰尽</span></span></p><span style="color: black;"><span style="color: black;">按照</span>心衰<span style="color: black;">出现</span>的<span style="color: black;">时间、速度、严重程度</span>可分为慢性心衰和急性心衰。</span><span style="color: black;">急性心衰系因急性的严重心肌损害、<span style="color: black;">心率</span>失常或<span style="color: black;">忽然</span>加重的心脏负荷,使心功能正常或<span style="color: black;">处在</span>代偿期的心脏在<span style="color: black;">短期</span>内<span style="color: black;">出现</span><span style="color: black;">衰尽</span>或慢性心衰急剧恶化。临床上以急性左心衰<span style="color: black;">平常</span>,表现为急性肺水肿或心源性休克。</span><span style="color: black;">慢性心衰有-个缓慢的发展过程,<span style="color: black;">通常</span>均有代偿性心脏扩大或肥厚及其他代偿机制的参与。</span><span style="color: black;">(三）射血分数降低性心衰( HFrEF)和射血分数<span style="color: black;">保存</span>性心衰（HFpEF)</span><span style="color: black;"><span style="color: black;">针对</span>心衰的描述<span style="color: black;">重点</span>基于左室射血分数( left ventricular ejection fraction ,LVEF)。<span style="color: black;">LVEF<40%者<span style="color: black;">叫作</span>为射血分数降低性心衰</span>(HF with reduced EF ,HFrEF),即传统概念中的收缩性心衰。<span style="color: black;">LVEF≥50%的心衰<span style="color: black;">叫作</span>为射血分数<span style="color: black;">保存</span>性心衰(HF with preserved EF ,HFpEF) ,</span><span style="color: black;">一般</span>存在左室肥厚或左房增大等充盈压<span style="color: black;">上升</span>,舒张功能受损的表现,以前<span style="color: black;">叫作</span>为舒张性心衰。大<span style="color: black;">都数</span>HFEF病人<span style="color: black;">同期</span>存在舒张功能不全，而HFpEF病人<span style="color: black;">亦</span>可能<span style="color: black;">同期</span>存在非常轻微的收缩功能<span style="color: black;">反常</span>。<span style="color: black;">LVEF在40% ~49%之间者<span style="color: black;">叫作</span>为中间范围射血分数心衰( HF with mid-range EF ,HFmrEF) ,</span>这些病人<span style="color: black;">一般</span>以轻度收缩功能<span style="color: black;">阻碍</span>为主,<span style="color: black;">同期</span>伴有舒张功能不全的特点。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3、Killip分级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Ⅰ级:尚<span style="color: black;">没</span><span style="color: black;">显著</span>心力<span style="color: black;">衰尽</span>;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Ⅱ级:有左心<span style="color: black;">衰尽</span>,肺部哕音<50%肺野;.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Ⅲ级:有急性肺水肿,全肺大、小、干、湿哕音;</p>Ⅳ级:有心源性休克等不同程度或<span style="color: black;">周期</span>的血流动力学变化。
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、NYHA分级</span></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;">Ⅰ</span>
</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">级:<span style="color: black;">通常</span>体力活动(如步行和登楼)不受限,仅在强、快或<span style="color: black;">连续</span>用力时<span style="color: black;">出现</span>心绞痛。</p><span style="color: black;">Ⅱ</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">级:<span style="color: black;">通常</span>体力活动轻度受限。快步、饭后、寒冷或刮风中、精神应激或醒后数小时内<span style="color: black;">爆发</span>心绞痛。<span style="color: black;">通常</span><span style="color: black;">状况</span>下平地步行200m以上或登楼-层以上受限。</p><span style="color: black;">Ⅲ</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">级:<span style="color: black;">通常</span>体力活动<span style="color: black;">显著</span>受限,<span style="color: black;">通常</span><span style="color: black;">状况</span> 下平地步行200m内或登楼一层<span style="color: black;">导致</span>心绞痛。</p><span style="color: black;">Ⅳ</span>级:轻微活动或<span style="color: black;">休憩</span>时<span style="color: black;">就可</span><span style="color: black;">出现</span>心绞痛。
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5、心力<span style="color: black;">衰尽</span>分期</span></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;">前</span>心力<span style="color: black;">衰尽</span><span style="color: black;">周期</span>（A期）：高危人群，<span style="color: black;">没</span>结构功能变、<span style="color: black;">没</span>临床表现。</span></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;">前临床</span>心力<span style="color: black;">衰尽</span><span style="color: black;">周期</span>（B期）：<span style="color: black;">有<span style="color: black;">结构功能变</span></span><span style="color: black;">，<span style="color: black;">没</span>临床表现。</span></span></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;">临床</span><span style="color: black;">心力<span style="color: black;">衰尽</span><span style="color: black;">周期</span>（C期）<span style="color: black;">：有<span style="color: black;">结构功能变</span>，有临床表现。</span></span></span></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;">难</span><span style="color: black;">治性终末期心力<span style="color: black;">衰尽</span><span style="color: black;">周期</span>（D期）<span style="color: black;">：需心脏移植。</span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6、6分钟步行<span style="color: black;">实验</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">150-450m 中度心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7、休克指数</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">=脉率/收缩压=0.5 ≥1：休克</span></p><span style="color: black;">超声心动图更准确地<span style="color: black;">评估</span>各心腔<span style="color: black;">体积</span>变化及瓣膜结构和功能,方便快捷地<span style="color: black;">评定</span>心功能和判断病因,是<span style="color: black;">论断心力<span style="color: black;">衰尽</span><strong style="color: blue;">最<span style="color: black;">重点</span></strong>的仪器<span style="color: black;">检测</span>。</span></span><span style="color: black;">(1)）收缩功能:以收缩末及舒张末的容量差计算LVEF<span style="color: black;">做为</span>心力<span style="color: black;">衰尽</span>的诊断指标,虽<span style="color: black;">不足</span>精确，但方便实用。</span><span style="color: black;">(2）舒张功能:超声多普勒是临床上最实用的判断舒张功能的<span style="color: black;">办法</span>。可有<span style="color: black;">引起</span>舒张期功能不全的结构<span style="color: black;">基本</span>,如左心房肥大、左心室壁增厚等。心动周期中舒张<span style="color: black;">初期</span>心室充盈速度最大值为E峰,舒张晚期(心房收缩)心室充盈最大值为A峰<span style="color: black;">,E/A比值正<span style="color: black;">一般人</span><span style="color: black;">不该</span><span style="color: black;">少于</span>1.2,中青年更大。</span><span style="color: black;">舒张功能不全时,E峰下降,A峰<span style="color: black;">升高</span>,E/A比值降低。</span><span style="color: black;">针对</span>难以准确<span style="color: black;">评估</span>A峰的心房颤动病人,可利用组织多普勒<span style="color: black;">评定</span>二尖瓣环测得E/E比值,若>15,则提示存在舒张功能不全。但尚需<span style="color: black;">按照</span>病人临床表现综合<span style="color: black;">评估</span><span style="color: black;">可否</span>存在舒张功能不全,而<span style="color: black;">不可</span>单纯依据超声结果进行诊断。</span><span style="color: black;">X线<span style="color: black;">检测</span>是确诊左心<span style="color: black;">衰尽</span>肺水肿的<span style="color: black;">重点</span>依据,并有助于心衰与肺部<span style="color: black;">疾患</span>的鉴别。心影<span style="color: black;">体积</span>及形态为心脏病的病因诊断<span style="color: black;">供给</span>了<span style="color: black;">要紧</span>的参考资料,心脏扩大的程度和动态改变<span style="color: black;">亦</span>间接反映了心脏的功能状态,但并非所有心衰病人均存在心影增大。</span><span style="color: black;">X线胸片可反映肺淤血。<span style="color: black;">初期</span>肺静脉压<span style="color: black;">升高</span>时,<span style="color: black;">重点</span>表现为肺门血管影<span style="color: black;">加强</span>,上肺血管影<span style="color: black;">增加</span>与<span style="color: black;">下肺纹理密度相仿<span style="color: black;">乃至</span>多于下肺。肺动脉压力<span style="color: black;">升高</span>可见右下肺动脉增宽,进一步<span style="color: black;">显现</span>间质性肺水肿可使肺野模糊,</span><span style="color: black;">Kerley B线是在肺野外侧清晰可见的水平线状影,是肺小叶间隔内积液的表现,是慢性肺淤血的特征性表现。</span><span style="color: black;">急性肺泡性肺水肿时肺门呈蝴蝶状,肺野可见大片融合的<span style="color: black;">暗影</span>。左心<span style="color: black;">衰尽</span>还可见胸腔积液和叶间胸膜增厚。</span></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibaqMspJh4afwDIJCuwF7JANMJ1icJ4E6wpXPJ2c7yp9fwGQGQVKRia5Rg/640?wx_fmt=png&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;"><span style="color: black;">1、Forrester分型 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.正常时 CI（心脏指数）>2.5L/(min*㎡) PCWP(肺小动脉楔压)＜12mmHg</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.肺充血 PCWP＞12<span style="color: black;">mmHg </span> CI>2.5 <span style="color: black;">/(min*㎡)</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.<span style="color: black;">周边</span>组织灌注不足 PCWP＜12<span style="color: black;">mmHg </span> CI＜2.5<span style="color: black;">/(min*㎡)</span> </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.肺充血与<span style="color: black;">周边</span>组织灌注不足 PCWP＞12<span style="color: black;">mmHg </span> CI＜2.5<span style="color: black;">/(min*㎡)</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰的治疗<span style="color: black;">目的</span>为防止和延缓心力<span style="color: black;">衰尽</span>的<span style="color: black;">出现</span>发展;缓解临床症状,<span style="color: black;">加强</span>生活质量;改善<span style="color: black;">长时间</span>预后,降低病死率与住院率。治疗原则:采取综合治疗<span style="color: black;">办法</span>,<span style="color: black;">包含</span>对<span style="color: black;">各样</span>可致心功能受损的<span style="color: black;">疾患</span>如冠心病、高血压、糖尿病的<span style="color: black;">初期</span>管理,调节心力<span style="color: black;">衰尽</span>的代偿机制,减少其<span style="color: black;">消极</span>效应,如拮抗神经体液因子的过度激活,阻止或延缓心室重塑的<span style="color: black;">发展</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(一）<span style="color: black;">通常</span>治疗1．生活方式管理</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1）病人教育:心衰病人及家属应得到准确的<span style="color: black;">相关</span><span style="color: black;">疾患</span>知识和管理的<span style="color: black;">指点</span>,内容<span style="color: black;">包含</span>健康的生活方式、<span style="color: black;">安稳</span>的<span style="color: black;">心情</span>、适当的诱因规避、规范的<span style="color: black;">药品</span><span style="color: black;">吃下</span>、<span style="color: black;">恰当</span>的随访计划等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)体重管理:<span style="color: black;">平常</span>体重监测能简便直观地反映病人体液潴留<span style="color: black;">状况</span>及利尿剂疗效,<span style="color: black;">帮忙</span><span style="color: black;">指点</span><span style="color: black;">调节</span>治疗<span style="color: black;">方法</span>。体重改变<span style="color: black;">常常</span>出<span style="color: black;">此刻</span>临床体液潴留症状和体征之前。部分严重慢性心力衰竭病人存在临床或亚临床营养不良,若病人<span style="color: black;">显现</span><span style="color: black;">海量</span>体脂丢失或干重减轻<span style="color: black;">叫作</span>为心源性恶病质,<span style="color: black;">常常</span>预示预后不良。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(3）<span style="color: black;">膳食</span>管理:心衰病人血容量<span style="color: black;">增多</span>,<span style="color: black;">身体</span>水钠潴留,减少钠盐摄人有利于减轻<span style="color: black;">以上</span><span style="color: black;">状况</span>,但在应用强效排钠利尿剂时过分严格限盐可<span style="color: black;">引起</span>低钠血症。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.<span style="color: black;">休憩</span>与活动急性期或病情不稳定者应限制体力活动,卧床<span style="color: black;">休憩</span>,以降低心脏负荷,有利于心功能的恢复。但<span style="color: black;">长时间</span>卧床易<span style="color: black;">出现</span>深静脉血栓形成<span style="color: black;">乃至</span>肺栓塞,<span style="color: black;">同期</span><span style="color: black;">亦</span>可能<span style="color: black;">显现</span>消化功能减低,肌肉萎缩、坠积性肺炎、压疮等,适宜的活动能<span style="color: black;">加强</span>骨骼肌功能,改善活动耐量。<span style="color: black;">因此呢</span>,应鼓励病情稳定的心衰病人主动运动,<span style="color: black;">按照</span>病情轻重不同,在不诱发症状的前提下从床边小坐<span style="color: black;">起始</span>逐步<span style="color: black;">增多</span>有氧运动。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.病因治疗</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1）病因治疗:对所有可能<span style="color: black;">引起</span>心脏功能受损的<span style="color: black;">平常</span><span style="color: black;">疾患</span>如高血压,冠心病、糖尿病、代谢<span style="color: black;">综合症</span>等,在尚未<span style="color: black;">导致</span>心脏器质性改变前即应<span style="color: black;">初期</span>进行有效治疗。<span style="color: black;">针对</span><span style="color: black;">少许</span>病因未明的<span style="color: black;">疾患</span>如原发性扩张型心肌病等<span style="color: black;">也</span>应<span style="color: black;">初期</span>积极<span style="color: black;">干涉</span>,延缓<span style="color: black;">疾患</span><span style="color: black;">发展</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2）消除诱因:<span style="color: black;">平常</span>的诱<span style="color: black;">由于</span>感染,<span style="color: black;">尤其</span>是<span style="color: black;">呼气</span>道感染,应积极<span style="color: black;">选择</span>适当的抗感染治疗。快心室率心房颤动应尽快<span style="color: black;">掌控</span>心室率,如有可能应<span style="color: black;">即时</span>复律。应<span style="color: black;">重视</span>排查及纠正潜在的甲状腺功能<span style="color: black;">反常</span>,贫血等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">药品</span>治疗</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/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibRG7jnfHyFY7NRQcsptvU9N7HacM29qXbwnpMmP2hELYfstfZIr0S1w/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibbT0nhicfHpc9pPGxEzrdhpkOlGojxA2JGycum8GNG0PoDTZy47dz1iaw/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib7ggLmj5tibUSXyAUmibHSFIiaB2qkgEjN64ib14s44kAEcibu6ibJ2ib8MbNA/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibanY7wGjc4nFR57aibM6LlCEjJCFk6zKCzjxmxD6z3cyGtfwwZz7uwMg/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibh26xsGKke1LHlgHcvQEHicgK5KYX2RXl8JGpXc1JVsO9C9VKVOhtYPg/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib8Kkm5euzSGKWAINKTR1EZe5gSxuia8C2g4ibw336VibvrJw7j3CUPZong/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib0hjKfXCvqN77py2Zn0cXg7UyYJWW9m0TMBYLanz3HOfLhXR248tedQ/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib0t6q1bauHXF0QhBdkbpYf8ro8U0MR0KuqNye6v6oQttBOSe9MD7weA/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibntduChRIJSLlLsGP9wHFNcZKHfbUdJ6grUvPc8duiaSDgeDQ8JoxiaqA/640?wx_fmt=png&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;">急性心力<span style="color: black;">衰尽</span></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/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib9ANGPbXqxvenDia4338hyBIeYbSKoZfcKbYEUBBLzRhbhblR8BPbcMw/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ib6coLia3zKrhChw8fsVJf0uplxibazPRPyxKbK4Iia1cb51bbQJ8CtbJSQ/640?wx_fmt=png&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;"><img src="https://mmbiz.qpic.cn/mmbiz_png/YH88YbIVicfwaoDnzfjQdgZKGNyW35M1ibQcsU9xR85mlv4vjS5nXyX2sWDmjSVibE2xNM9K3DKHXZeuUEwbtSkPw/640?wx_fmt=png&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;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" 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="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性左心<span style="color: black;">衰尽</span>的处理</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" 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="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
“沙发”（SF，第一个回帖的人） 软文发布论坛开幕式圆满成功。 http://www.fok120.com 感谢楼主的分享！我学到了很多。 你的言辞如同繁星闪烁，点亮了我心中的夜空。 我深感你的理解与共鸣，愿对话长流。
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