慢性左心衰，早认识早获益
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/ZJG3kKpKoiapyJyJeMmf0up2zsAopQfVVGHDzsXlq7tibOTnLiaficBEvF84KXKRY1FqlMUlIDlX1UNicoBdkibwLLxg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=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;"><span style="color: black;">日前</span>，我国心血管<span style="color: black;">疾患</span>患病人数高达3.3亿，其中心力<span style="color: black;">衰尽</span>的发病率呈逐年<span style="color: black;">增多</span>趋势。<span style="color: black;">截止</span>2022年11月，我国心衰<span style="color: black;">病人</span>已高达890万人，其<span style="color: black;">存活</span>率与<span style="color: black;">平常</span>的癌症相当，再住院率和病死率居高不下。心衰的<span style="color: black;">归类</span>之中，慢性左心衰尤其<span style="color: black;">必须</span><span style="color: black;">大众</span>的关注。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性左心衰，一颗“<span style="color: black;">按时</span>炸弹”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span>，简<span style="color: black;">叫作</span>“心衰”，是<span style="color: black;">各样</span>心脏<span style="color: black;">疾患</span>的严重表现或晚期<span style="color: black;">周期</span>。心脏就像一个“水泵”，<span style="color: black;">一直</span>地<span style="color: black;">经过</span>动脉把血液<span style="color: black;">传送</span>到全身，<span style="color: black;">同期</span>接受静脉从<span style="color: black;">周边</span>组织脏器<span style="color: black;">传送</span>回心脏的血液，心脏泵血功能衰退，射血功能下降，<span style="color: black;">引起</span>输<span style="color: black;">流血</span>量<span style="color: black;">不可</span>满足身体代谢<span style="color: black;">必须</span>；器官和组织中的血液<span style="color: black;">亦</span><span style="color: black;">不可</span>顺利回流到心脏，<span style="color: black;">引起</span>身体其他组织淤血肿胀，可能<span style="color: black;">显现</span><span style="color: black;">呼气</span>困难、乏力、水肿等表现。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/ZJG3kKpKoiap88ZicBYuemUtVxLxZDumHeia0YJlBHMCLTYgACqSbOtibUaew6GicPUYzS6b7URgIqTMxXLdcLQ96kg/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;"><span style="color: black;">心衰可分为左心衰、右心衰和晚期的全心<span style="color: black;">衰尽</span>，其中左心衰在临床上最<span style="color: black;">平常</span>。慢性左心衰的<span style="color: black;">害处</span>可累及全身各处，最<span style="color: black;">显著</span>的是程度不同的<span style="color: black;">呼气</span>困难。除了<span style="color: black;">呼气</span>困难，慢性左心衰<span style="color: black;">病人</span>还会<span style="color: black;">显现</span>咳嗽、咳痰、咯血；乏力、疲倦、<span style="color: black;">头昏</span>、心慌；少尿及肾功能损害症状。左心<span style="color: black;">衰尽</span><span style="color: black;">出现</span>后，肺动脉压力<span style="color: black;">升高</span>，使右心负荷加重，<span style="color: black;">长期</span>后，右心<span style="color: black;">衰尽</span><span style="color: black;">亦</span>随之<span style="color: black;">显现</span>。心衰最<span style="color: black;">要紧</span>的<span style="color: black;">害处</span>是缩短寿命。据<span style="color: black;">科研</span>报告，心衰的5年存活率约为50%，与恶性肿瘤相当，且随着病程的延长，心功能下降越多，存活率就越低。严重心衰<span style="color: black;">病人</span>随时可能<span style="color: black;">出现</span>心源性猝死</span><span style="color: black;">②</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰是<span style="color: black;">各样</span>心脏<span style="color: black;">疾患</span>的严重表现或晚期<span style="color: black;">周期</span>。对国内10714例住院心衰<span style="color: black;">病人</span>的调查<span style="color: black;">表示</span>：1980、1990、2000年心衰<span style="color: black;">病人</span>住院<span style="color: black;">时期</span>病死率分别为15.4%、12.3%和6.2%，<span style="color: black;">重点</span>死亡<span style="color: black;">原由</span>首位为左心<span style="color: black;">衰尽</span>，占比59%，其他<span style="color: black;">原由</span>依次为<span style="color: black;">心率</span>失常（13%）和心脏性猝死（13%）</span><span style="color: black;">③</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性左心衰的病因和临床表现</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">几乎所有类型的心脏、大血管<span style="color: black;">疾患</span>均<span style="color: black;">能够</span><span style="color: black;">导致</span>心力<span style="color: black;">衰尽</span>，如冠心病、高血压、<span style="color: black;">长时间</span>的<span style="color: black;">心率</span>失常等。心力<span style="color: black;">衰尽</span>反应心脏的泵血功能<span style="color: black;">阻碍</span>，<span style="color: black;">亦</span><span style="color: black;">便是</span>心肌的舒缩功能不全，<span style="color: black;">最后</span><span style="color: black;">引起</span>心肌功能由代偿发展为失代偿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/ZJG3kKpKoiap88ZicBYuemUtVxLxZDumHeialmfedjs4C78m8sJ8ibje5vic9Ac5sunI4f3pIws3zyGmNhqC2JaOuqA/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;"><span style="color: black;">慢性左心衰的临床表现集中在对肺功能影响，<span style="color: black;">重点</span><span style="color: black;">包含</span>：</span></p><span style="color: black;">程度不同的<span style="color: black;">呼气</span>困难</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">劳力性<span style="color: black;">呼气</span>困难：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;">端坐<span style="color: black;">呼气</span>：端坐<span style="color: black;">呼气</span>指<span style="color: black;">病人</span>为了减轻<span style="color: black;">呼气</span>困难被迫采取端坐位或半卧位的状态。肺淤血达到<span style="color: black;">必定</span>程度，平卧时<span style="color: black;">呼气</span>更加困难，<span style="color: black;">必要</span>采取端坐位<span style="color: black;">呼气</span>；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">夜间阵发性<span style="color: black;">呼气</span>困难：<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;">2.急性肺水肿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这是“心源性哮喘”的进一步<span style="color: black;">发展</span>，是左心<span style="color: black;">衰尽</span><span style="color: black;">呼气</span>困难最严重的形式。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.咳嗽、咳痰和咯血</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">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。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.其他表现</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心脏排出量不足，器官、组织灌注不足及代偿性心率加快<span style="color: black;">导致</span>的乏力、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><img src="https://mmbiz.qpic.cn/mmbiz_png/cWZ4ibXEPpTMHm4I6xfENmlRdam9Wyl3Wg5Y0wWu5FgyCfyrfslAcwL79THbicG1DgGY1JFBW6xqOIIXvl2dGaXg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/ibjOmHcC65NT4ic9QYwKiaQ28N0WjXn7fNDPEEcsomYqtU3nUAcsndu3jgehbkRzM8QX4gYaaM15FKz4HAZMGZ0gg/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;">健康小贴士</strong></p>
<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>症状有何不同？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左心衰竭<span style="color: black;">重点</span>是把血液<strong style="color: blue;">淤积在肺里</strong>，<span style="color: black;">引起</span>全身各脏器供血不足。右心<span style="color: black;">衰尽</span><span style="color: black;">重点</span>把血液<strong style="color: blue;">淤滞在全身各处</strong>，<span style="color: black;">同期</span>向<strong style="color: blue;">肺动脉供血不足</strong>。<span style="color: black;">重点</span>表现为<span style="color: black;">头昏</span>、心慌、尿少、全身乏力等脏器缺血的表现。右心<span style="color: black;">衰尽</span><span style="color: black;">能够</span>表现为进入肺动脉的血量<span style="color: black;">亦</span>少，<span style="color: black;">引起</span>参与肺的气体交换的血量减少，机体缺氧<span style="color: black;">亦</span><span style="color: black;">能够</span>表现为<span style="color: black;">呼气</span>困难<span style="color: black;">④</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">按时</span>炸弹”引爆之前，<span style="color: black;">咱们</span>能做什么？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.积极<span style="color: black;">药品</span>治疗</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">慢性左心衰的治疗<span style="color: black;">目的</span>是减缓或阻止心衰的<span style="color: black;">出现</span>，缓解临床心衰<span style="color: black;">病人</span>的症状，延缓其<span style="color: black;">长时间</span>预后及降低死亡率。治疗应遵循个体化原则，动态<span style="color: black;">评定</span><span style="color: black;">病人</span><span style="color: black;">伴同</span><span style="color: black;">疾患</span>的变化及相应合并用药的<span style="color: black;">调节</span><span style="color: black;">状况</span>，<span style="color: black;">即时</span><span style="color: black;">调节</span>治疗<span style="color: black;">方法</span>。<span style="color: black;">药品</span><span style="color: black;">选取</span>上，除了利尿剂这类基石<span style="color: black;">药品</span>，还<span style="color: black;">能够</span><span style="color: black;">按照</span>个体<span style="color: black;">状况</span><span style="color: black;">选取</span>血管紧张素转化酶<span style="color: black;">控制</span>剂（ACEI，如雷米普利等），ACEI类<span style="color: black;">药品</span>可降低老年<span style="color: black;">病人</span>心衰恶化再住院率和死亡率</span><span style="color: black;">⑤</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.严格限制液体摄入</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/ZJG3kKpKoiap88ZicBYuemUtVxLxZDumHe6URPtDCYqfV3GiaOaPmicZMOhiarOryiaZpsjd189z11vtsK2h6BO8JuaQ/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;"><span style="color: black;">心衰<span style="color: black;">病人</span>饮水要小口，慢慢饮水，不渴不要<span style="color: black;">太多</span>喝水。严重心衰<span style="color: black;">病人</span>摄入液体量限制在<span style="color: black;">每日</span>1.5～2.0升，有助于减轻症状并缓解肺淤血。<span style="color: black;">必须</span><span style="color: black;">重视</span>的是，严格限制液体摄入不仅限于<span style="color: black;">平常</span>饮水，汤、粥、蔬菜、<span style="color: black;">果蔬</span>中的“隐形水”<span style="color: black;">亦</span>要一并计算。<span style="color: black;">同期</span>，心衰<span style="color: black;">病人</span><span style="color: black;">亦</span>要<span style="color: black;">定时</span>去查体重，<span style="color: black;">短期</span>内体重<span style="color: black;">增多</span>是身<span style="color: black;">身体</span>液体潴留的“信号”，<span style="color: black;">此时</span>就应该咨询<span style="color: black;">大夫</span><span style="color: black;">调节</span><span style="color: black;">药品</span>治疗，减少心衰<span style="color: black;">爆发</span>频率。</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;">掌控</span>钠盐摄入</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰<span style="color: black;">病人</span>血容量<span style="color: black;">增多</span>，且<span style="color: black;">身体</span>存在水钠潴留，<span style="color: black;">因此呢</span>应减少钠盐摄入，有利于减轻水肿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.做好个人管理</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">·积极改变生活方式：戒烟戒酒，戒除<span style="color: black;">药品</span>依赖等；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">·<span style="color: black;">定时</span>复诊：<span style="color: black;">大夫</span><span style="color: black;">按照</span><span style="color: black;">病人</span>近期<span style="color: black;">情况</span>进行个体化<span style="color: black;">调节</span>；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">·适量运动：<span style="color: black;">意见</span>心衰<span style="color: black;">病人</span>进行有规律的有氧运动，以改善症状、<span style="color: black;">加强</span>活动耐量；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">·<span style="color: black;">保持</span>服药，遵从医嘱：不擅自停药、<span style="color: black;">减少</span>；未经专科<span style="color: black;">大夫</span>同意不擅自加用其他<span style="color: black;">药品</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考资料</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①心力<span style="color: black;">衰尽</span>知多少一文<span style="color: black;">认识</span>,健康中国,2021-11-26.</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">②心衰是个什么病，<span style="color: black;">能够</span>预防吗？中国医学救援协会,2021-01-26.</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③中华医学会心血管病学分会心力<span style="color: black;">衰尽</span>学组,等.中华心血管病杂志,2018,46(10):760-789.</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">④左心<span style="color: black;">衰尽</span>和右心<span style="color: black;">衰尽</span>的症状不同？每日医学文库,2021-06-29.</p>
</span><span style="color: black;">⑤中华医学会老年医学分会心血管<span style="color: black;">疾患</span>学组,等.中华老年医学杂志,2021,40(5):550-561.</span>
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你的话语如春风拂面，让我感到无比温暖。 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。 你的见解真是独到，让我受益匪浅。
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