人民心声 || 心衰，不可喝的奥密（一）
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">点击蓝字关注这个神奇的公众号～</p><span style="color: black;">“</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">医生</span>说：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">倘若</span>刘<span style="color: black;">专家</span>不收你住院的话，</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 那你就只能等着……</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">他说：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">是否</span>只能等着老天来收了呀？</p><span style="color: black;">”</span><img src="https://mmbiz.qpic.cn/mmbiz_gif/rYe7Q4b1HPyrr9fRxf8B7eHF1k6ZmicBia5tv3Wcf3p6dA3K5x99HI8vEcZziccic56eulLOHiccGZZQe2kSe9xWUDA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=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;">壹</span></strong>个月前，W病人还像往常<span style="color: black;">同样</span>，在家里干着活儿。<span style="color: black;">然则</span>，跟往常不<span style="color: black;">同样</span>的是：怎么就<span style="color: black;">没</span>缘<span style="color: black;">没</span>故的，老是咳嗽、喘不上来气呢？<span style="color: black;">夜晚</span>睡觉，<span style="color: black;">基本</span>没办法躺下，一平躺就咳嗽，就觉得气<span style="color: black;">不足</span>用，垫着很高的枕头，<span style="color: black;">才可</span>勉强睡着。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">到医院去做<span style="color: black;">检测</span>，<span style="color: black;">医生</span>告诉他：心脏出问题了！<strong style="color: blue;">憋气，睡觉躺不平，这都是<span style="color: black;">心力衰竭</span>的表现。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">W病人拿着超声心动图的结果报告，<span style="color: black;">满脸</span>的焦虑：节段性室壁运动<span style="color: black;">反常</span>，左心增大，主动脉瓣返流，二尖瓣返流，三尖瓣返流，肺动脉高压，左室功能减低，射血分数38%。再做个冠脉造影<span style="color: black;">检测</span>，前降支重度狭窄。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">瓣膜病+冠心病，心脏竟然病得如此全面。。。经过一段时间的治疗，W病人感觉并<span style="color: black;">无</span>好<span style="color: black;">有些</span>，当地的<span style="color: black;">医生</span>对他说：……<span style="color: black;">况且</span>，你这个心衰太严重了，<span style="color: black;">咱们</span>处理不了。你去北京吧，找刘<span style="color: black;">专家</span><span style="color: black;">瞧瞧</span>，<span style="color: black;">倘若</span>刘<span style="color: black;">专家</span>不收你住院的话，那你就只能等着……W病人心头一颤：<span style="color: black;">是否</span>只能等着老天来收了呀？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <strong style="color: blue;">什么是心力衰竭？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心力衰竭（heart failure）简<span style="color: black;">叫作</span>心衰，<span style="color: black;">指的是</span><span style="color: black;">因为</span>心脏的收缩功能和（或）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>将静脉回心血量充分排出心脏，<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，从而<span style="color: black;">导致</span>心脏循环<span style="color: black;">阻碍</span>症候群。心力衰竭并不是一个独立的<span style="color: black;">疾患</span>，而是心脏<span style="color: black;">疾患</span>发展的终末<span style="color: black;">周期</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">根据</span>心衰的<span style="color: black;">出现</span>的部位，<span style="color: black;">能够</span>分为左心、右心和全心衰竭。其中绝大<span style="color: black;">都数</span>的心力衰竭都是以左心衰竭<span style="color: black;">起始</span>的，即<span style="color: black;">首要</span>表现为肺循环淤血；右心衰则是以体循环淤血为<span style="color: black;">重点</span>表现。</p><img src="https://mmbiz.qpic.cn/mmbiz_png/ibtb4my3dFeGhwicCy0ydMf7YRNSraOEFm4UbqGoVsOSBX3Z28Yf6ibdFdFZrLwafiaevAJtcyT2uz3OxiaP1rxWeHA/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;">先聊聊左心衰</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;"><span style="color: black;">呼气</span>困难 </span></strong>是左心衰竭的最早和最<span style="color: black;">平常</span>的症状。<span style="color: black;">重点</span><span style="color: black;">因为</span>急性或慢性肺瘀血和肺活量减低所<span style="color: black;">导致</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 轻者仅于较重的体力劳动时<span style="color: black;">出现</span><span style="color: black;">呼气</span>困难，<span style="color: black;">休憩</span>后<span style="color: black;">火速</span>消失，故<span style="color: black;">叫作</span>为<span style="color: black;">劳力性<span style="color: black;">呼气</span>困难</span>。此<span style="color: black;">因为</span>劳动<span style="color: black;">促进</span>回心血量<span style="color: black;">增多</span>，在右心功能正常时，更<span style="color: black;">促进</span>肺瘀血加重的缘故。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 随病情的<span style="color: black;">发展</span>，轻度体力活动即感<span style="color: black;">呼气</span>困难，严重者<span style="color: black;">休憩</span>时<span style="color: black;">亦</span>感<span style="color: black;">呼气</span>困难，<span style="color: black;">导致</span>被迫采取半卧位或坐位，<span style="color: black;">叫作</span>为<span style="color: black;">端坐<span style="color: black;">呼气</span></span>（迫坐<span style="color: black;">呼气</span>）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">阵发性夜间<span style="color: black;">呼气</span>困难</span>是左心衰竭的一种表现，病人常在熟睡中憋醒，有窒息感，被迫坐起，咳嗽频繁，<span style="color: black;">显现</span>严重的<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;"><strong style="color: blue;"><span style="color: black;">咳嗽和咯血 </span></strong>是左心衰竭的<span style="color: black;">平常</span>症状。<span style="color: black;">因为</span>肺泡和支气管粘膜淤血所<span style="color: black;">导致</span>，多与<span style="color: black;">呼气</span>困难并存，咯血色<span style="color: black;">泡泡</span>样或血样痰。</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/ibtb4my3dFeGhwicCy0ydMf7YRNSraOEFmUoiaph0diaZpKDE2lNDfwJlHAVVMsd0iaQMvias1icsBoe9MEleeX2nwl9g/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;">正如Fan<span style="color: black;">医生</span>在<span style="color: black;">伴侣</span>圈里发的……</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">原由</span>是啥呢：<span style="color: black;">由于</span>血液受重力影响，坐着的时候，大多会积聚在低垂部位（如下肢和腹部），回心血量会比平卧时减少，肺淤血减轻，<span style="color: black;">同期</span>坐着的时候膈肌下降，肺活量<span style="color: black;">增多</span>，从而减轻<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;"><strong style="color: blue;">心衰的<span style="color: black;">评估</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病人一旦<span style="color: black;">显现</span>充血性心力衰竭的症状后，按心功能的<span style="color: black;">状况</span>可分为<strong style="color: blue;">四级</strong><span style="color: black;">(<span style="color: black;">1928年纽约心脏病协会分级，美国心脏病协会标准委员会1994年修订)：</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">I级</strong>：体力活动不受限制。<span style="color: black;">平常</span>活动不<span style="color: black;">导致</span>乏力、心悸、<span style="color: black;">呼气</span>困难或心绞痛等症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Ⅱ级</strong>：体力活动轻度受限。<span style="color: black;">休憩</span>时<span style="color: black;">没</span>症状，<span style="color: black;">平常</span>活动<span style="color: black;">就可</span><span style="color: black;">导致</span>乏力、心悸、<span style="color: black;">呼气</span>困难或心绞痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Ⅲ级</strong>：体力活动<span style="color: black;">显著</span>受限。<span style="color: black;">休憩</span>时<span style="color: black;">没</span>症状，轻于<span style="color: black;">平常</span>的活动<span style="color: black;">就可</span><span style="color: black;">导致</span><span style="color: black;">以上</span>症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">IV级</strong>：<span style="color: black;">不可</span>从事任何体力活动。<span style="color: black;">休憩</span>时<span style="color: black;">也</span>有症状，体力活动后加重。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">AHA在1994年修订标准<span style="color: black;">增多</span>了客观评定的分级标准，<span style="color: black;">按照</span>心电图、运动<span style="color: black;">实验</span>、X射线和超声心动图等客观<span style="color: black;">检测</span>作出分级，<span style="color: black;">亦</span>分为<strong style="color: blue;">四级</strong>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">A级</strong>：<span style="color: black;">没</span>心血管<span style="color: black;">疾患</span>的客观证据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">B级</strong>：轻度心血管<span style="color: black;">疾患</span>的客观证据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">C级</strong>：中度心血管<span style="color: black;">疾患</span>的客观证据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">D级</strong>：重度心血管<span style="color: black;">疾患</span>的客观证据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">例如病人<span style="color: black;">没</span>症状，但跨主动脉瓣压力阶差很大，则判为：心功能I级，客观评定D级。</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;">那样</span>咱们的W病人，是什么等级呢？</span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/rYe7Q4b1HPyrr9fRxf8B7eHF1k6ZmicBia5tv3Wcf3p6dA3K5x99HI8vEcZziccic56eulLOHiccGZZQe2kSe9xWUDA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=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;">W</span></strong>病人顺利地住在了<strong style="color: blue;"><span style="color: black;">北京大学人民医院心脏外科</span></strong>，满怀<span style="color: black;">期盼</span>又急切地等待着……<span style="color: black;">然则</span>，<span style="color: black;">每日</span>早上的例行查房，<span style="color: black;">刘刚副<span style="color: black;">专家</span>医师</span>和<span style="color: black;">赵舟主治医师</span>对他关心<span style="color: black;">更加多</span>的，却是“昨天尿了多少啊”，“<span style="color: black;">夜晚</span>睡觉好<span style="color: black;">有些</span>吗”，<span style="color: black;">这般</span>的琐事；护士们过来看他，<span style="color: black;">亦</span>不打针，<span style="color: black;">亦</span>不输液，<span style="color: black;">每日</span>就给几个小药片。。。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">眼瞅着<span style="color: black;">已然</span>过了一个多星期，“我的瓣膜坏了，<span style="color: black;">是否</span><span style="color: black;">医生</span>忘了要给我做手术啊，这可怎么办啊？”，W病人<span style="color: black;">最终</span>在一次查房到时候，表达了自己的焦虑。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不<span style="color: black;">晓得</span>，你<span style="color: black;">是否</span><span style="color: black;">亦</span>有<span style="color: black;">这般</span>的疑问：之前都说了，不做手术可能都活不下去的状态，<span style="color: black;">为何</span><span style="color: black;">医生</span>不赶快给他做手术，去救命呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Fan<span style="color: black;">医生</span>相信，带着问题去学习，知识会更牢靠！<span style="color: black;">那样</span>，咱们来<span style="color: black;">瞧瞧</span>专家怎么说吧：</p><img src="https://mmbiz.qpic.cn/mmbiz_png/ibtb4my3dFeGhwicCy0ydMf7YRNSraOEFm5Nn185wAHQNyY80I369PtQRb3wPIzjRaicGia2j9oVGMQYLiaSC4wibxrg/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;">容量管理——有<span style="color: black;">目的</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">容量超负荷</strong>是急、慢性心衰<span style="color: black;">出现</span>发展的<span style="color: black;">要紧</span>病理生理过程，<span style="color: black;">掌控</span>容量超负荷在心衰治疗中举足轻重。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咳，<span style="color: black;">这儿</span>的“容量”指的是血容量，<span style="color: black;">亦</span><span style="color: black;">便是</span>全身有效的循环血量。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><strong style="color: blue;">急性心衰</strong>的容量管理，<span style="color: black;">重点</span><span style="color: black;">经过</span><strong style="color: blue;"><span style="color: black;">尿量或液体平衡</span></strong><span style="color: black;">做为</span>治疗<span style="color: black;">目的</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">评定</span>容量负荷重，<span style="color: black;">每日</span>的尿量<span style="color: black;">目的</span><span style="color: black;">能够</span>达到3000-5000ml，直到达到最佳的容量状态；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">保持<span style="color: black;">每日</span>出入量负平衡约500ml，体重下降0.5<span style="color: black;">公斤</span>，严重肺水肿的<span style="color: black;">病人</span>，负平衡<span style="color: black;">达到</span>到1000-2000ml/天，<span style="color: black;">乃至</span>3000-5000ml/天，3-5天后，<span style="color: black;">倘若</span>肺淤血、水肿<span style="color: black;">显著</span>消退，应减少液体负平衡两，<span style="color: black;">逐步</span>过渡到出入量大体平衡。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><strong style="color: blue;">慢性心衰</strong>的容量管理，<span style="color: black;">重点</span>是以短期内部<span style="color: black;">显现</span>体重快速<span style="color: black;">增多</span>，<span style="color: black;">或</span>不<span style="color: black;">显现</span>心衰症状和体征加重为准。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"> 容量管理——有<span style="color: black;">办法</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1. 限</strong>：<span style="color: black;">首要</span><span style="color: black;">必须</span><span style="color: black;">知道</span>的一个<span style="color: black;">状况</span>，<span style="color: black;">便是</span>体重<span style="color: black;">连续</span><span style="color: black;">增多</span>的话，提示有容量超负荷的<span style="color: black;">状况</span>。（请不要抬杠，说吃多长肉。。。）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性D期的心衰<span style="color: black;">病人</span>，应该将液体摄入量<span style="color: black;">掌控</span>在1500-2000ml/天，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">按照</span>体重来设定，＜85<span style="color: black;">公斤</span>的<span style="color: black;">病人</span>，<span style="color: black;">每日</span>30ml/<span style="color: black;">公斤</span>，＞85<span style="color: black;">公斤</span>的<span style="color: black;">病人</span>，<span style="color: black;">每日</span>35ml/<span style="color: black;">公斤</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性心衰的<span style="color: black;">病人</span>，容量<span style="color: black;">掌控</span>应该更加严格，尤其是有循环淤血<span style="color: black;">状况</span>的。在<span style="color: black;">无</span><span style="color: black;">显著</span>的大<span style="color: black;">流血</span>、严重脱水、大汗淋漓等降低容量的<span style="color: black;">原因</span>时，<span style="color: black;">每日</span>摄入量<span style="color: black;">通常</span>应该<span style="color: black;">掌控</span>在1500ml以内，不要超过2000ml。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">——这，<span style="color: black;">便是</span><span style="color: black;">不可</span>喝的<span style="color: black;">奥密</span>！</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">2. 利</strong>：慢性心衰的<span style="color: black;">病人</span>，<span style="color: black;">必须</span><span style="color: black;">长时间</span>口服最小有效剂量的利尿剂治疗，而急性心衰的<span style="color: black;">或</span>慢性心衰失代偿的<span style="color: black;">病人</span>，<span style="color: black;">必须</span>静脉用药，用更大剂量的利尿剂。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">利尿剂<span style="color: black;">重点</span>有袢利尿剂、噻嗪类利尿剂、保钾利尿剂和血管加压素V2受体拮抗剂，这几种类型。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">常用的口服利尿剂和剂量<span style="color: black;">能够</span>参照下面的表格：</p><img src="https://mmbiz.qpic.cn/mmbiz_png/ibtb4my3dFeGhwicCy0ydMf7YRNSraOEFmRybibPnOakLQnf69X0RSNEnUhyLWCjia3Fpm3NIMnzsuxPjfv0AFgerQ/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/ibtb4my3dFeGhwicCy0ydMf7YRNSraOEFmZiaHiblFYAeIZJBVUBQyicgvdLjofMiaAUJ7NPkyZZc37TgiaHyQzujQmoQ/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;">3. 辅</strong>：有时候，单纯应用利尿剂效果并不太好，临床上常常会<span style="color: black;">选取</span><span style="color: black;">有些</span>辅助用药，<span style="color: black;">例如</span>多巴胺，能够扩张血管，<span style="color: black;">增多</span>肾脏的血流量，<span style="color: black;">加强</span>肾小球的滤过率。还有应用其他血管扩张剂，<span style="color: black;">或</span>重组人脑钠肽的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">4. 滤</strong>：<span style="color: black;">倘若</span>肾脏排尿的功能确实不行了，那就得考虑替代治疗了——血液超滤治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>中国、欧洲指南和日本"专家<span style="color: black;">意见</span>"均<span style="color: black;">举荐</span>血液超滤用于有<span style="color: black;">显著</span>的容量超负荷且常规利尿剂治疗效果<span style="color: black;">不良</span>的心衰<span style="color: black;">病人</span>，以快速缓解淤血症状和液体潴留。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/rYe7Q4b1HPyrr9fRxf8B7eHF1k6ZmicBia5tv3Wcf3p6dA3K5x99HI8vEcZziccic56eulLOHiccGZZQe2kSe9xWUDA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=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;">看</span></strong>到<span style="color: black;">这儿</span>，<span style="color: black;">大众</span>应该<span style="color: black;">晓得</span>，W病人吃的<span style="color: black;">哪些</span>小药片是干什么用的了吧——没错，<span style="color: black;">便是</span>利尿药。经过半个多月的<span style="color: black;">药品</span><span style="color: black;">调节</span>，再复查的超声心动图，结果提示心脏射血分数<span style="color: black;">已然</span><span style="color: black;">加强</span>到47.7%，比之前改善了10个百分点！</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">W病人<span style="color: black;">最终</span>能够<span style="color: black;">每日</span>踏踏实实地平躺着睡觉，<span style="color: black;">最终</span>体会到了<span style="color: black;">医生</span>们的良苦用心，<span style="color: black;">最终</span>做好了接受手术的准备……</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一个瓣膜一根桥——<span style="color: black;">主动脉瓣置换 + 左乳内动脉→前降支冠脉旁路移植</span>，手术后的W病人<span style="color: black;">每日</span>都乐呵呵的，每次看到Fan<span style="color: black;">医生</span>都会说：“哎呀，我<span style="color: black;">此刻</span>感觉可好了！是你们救了我一条命啊！”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">W病人的儿子说：“<span style="color: black;">医生</span>水平高，手术做的好！<span style="color: black;">咱们</span>这手术才做了5天，就能满地溜达了！<span style="color: black;">医生</span>，你们有时间<span style="color: black;">必定</span>要去<span style="color: black;">咱们</span>那里玩儿啊，黄河入海口，风景可好了，还有海鲜吃！”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Fan<span style="color: black;">医生</span>微微一笑：咱们心外科<span style="color: black;">医生</span>，可<span style="color: black;">不仅</span>是<span style="color: black;">仅有</span>手术好哦，病人术前、术后管理的本事，<span style="color: black;">亦</span>是要过硬的！</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/rYe7Q4b1HPyrr9fRxf8B7eHF1k6ZmicBia5tv3Wcf3p6dA3K5x99HI8vEcZziccic56eulLOHiccGZZQe2kSe9xWUDA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">好啦，今天的内容就到<span style="color: black;">这儿</span>了。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">是否</span>意犹未尽？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">确实，<span style="color: black;">针对</span>“<strong style="color: blue;"><span style="color: black;">主动脉瓣关闭不全</span></strong>”的介绍，相对比较少，<span style="color: black;">不碍事</span>，咱们……反正有<span style="color: black;">许多</span>时光！</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/ibtb4my3dFeHsTibLBrpN0w00beqFfxe6zZoNqPHntBxiafY1qN1RlG6MgwVM55icksyEtJTJ3hU6RLJ1ibTgoGicSng/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;">Fan<span style="color: black;">医生</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">北京大学人民医院 心外科</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重要</span>词：处女座。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其他的，还有必要说吗？</p><img src="https://mmbiz.qpic.cn/mmbiz_png/eUc6OIWib0fHxqpiaDcG66eHoh6KiaOIUanWWaKdr2z9o7xMwfFbpRTF1T3dWdFjQt4TgXnp4iaqlVficHNl7rY3ia8g/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/eUc6OIWib0fHxqpiaDcG66eHoh6KiaOIUana3RrIfeVRM0uY5ibFSVVwDFuCCv7ibtyuAN50rxJ1D2hl9zLjkm4dCYA/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_jpg/ibtb4my3dFeHsTibLBrpN0w00beqFfxe6zOGLOumHy6Ub1t5OHafCgW9cj5ZzSzibfvdC0RXdnMviaibN1YjhSx3qFA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
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