慢性左心衰的临床表现有哪些？
<div style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">1、</span>慢性心力<span style="color: black;">衰尽</span>症状是<span style="color: black;">这般</span>的</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 心力<span style="color: black;">衰尽</span>的临床表现与何侧心室或心房受累有密切关系。左心<span style="color: black;">衰尽</span>的临床特点<span style="color: black;">重点</span>是<span style="color: black;">因为</span>左心房和(或)右心室<span style="color: black;">衰尽</span><span style="color: black;">导致</span>肺瘀血、<span style="color: black;"><a style="color: black;">肺水肿</a></span>;而右心<span style="color: black;">衰尽</span>的临床特点是<span style="color: black;">因为</span>右心房和(或)右心室<span style="color: black;">衰尽</span><span style="color: black;">导致</span>体循环静脉瘀血和<span style="color: black;"><a style="color: black;">水钠潴留</a></span>。</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></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)<span style="color: black;">呼气</span>困难：是左心<span style="color: black;">衰尽</span>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;">包含</span>劳力性<span style="color: black;">呼气</span>困难，端坐<span style="color: black;">呼气</span>和<span style="color: black;"><a style="color: black;">夜间阵发性<span style="color: black;">呼气</span>困难</a></span>。<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>。<span style="color: black;"><a style="color: black;">阵发性夜间<span style="color: black;">呼气</span>困难</a></span>是左心<span style="color: black;">衰尽</span>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;"> (2)咳嗽、咳痰、<span style="color: black;"><a style="color: black;">咯血</a></span>，是肺泡和支气管粘膜淤血<span style="color: black;">导致</span>，<span style="color: black;">起始</span>常于夜间<span style="color: black;">出现</span>，坐位或立位时咳嗽可减轻，白色<span style="color: black;"><a style="color: black;">浆液</a>性<span style="color: black;">泡泡</span>状痰</span>为其特点。若支气管粘膜下形成的扩张的血管破裂，则可<span style="color: black;">导致</span><span style="color: black;"><a style="color: black;">大咯血</a></span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (3)其它：可有疲乏<span style="color: black;">没</span>力、失眠、<span style="color: black;"><a style="color: black;">心悸</a></span>、少尿及肾功能损害症状等。</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>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (1)上腹部胀满：是右心<span style="color: black;">衰尽</span>较早的症状。常伴有食欲不振、恶心、呕吐及上腹部胀痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (2)颈静脉怒张：是<span style="color: black;"><a style="color: black;">右心<span style="color: black;">衰尽</span></a></span>的一个较<span style="color: black;">显著</span>征象。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (3)水肿：<span style="color: black;"><a style="color: black;">心衰性水肿</a></span>多先见于下肢，呈凹陷性水肿，重症者可波及全身，<span style="color: black;"><a style="color: black;">下肢水肿</a></span>多于傍晚<span style="color: black;">显现</span>或加重，<span style="color: black;">休憩</span><span style="color: black;">一晚上</span>后可减轻或消失。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (4)紫绀：右心<span style="color: black;">衰尽</span>者多有不同程度的紫绀。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (5)神经系统症状：可有<span style="color: black;"><a style="color: black;">神经过敏</a></span>，失眠，嗜睡等症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> (6)心脏体征：<span style="color: black;">重点</span>为原有心脏病表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 3、全心<span style="color: black;">衰尽</span>：是右心衰继发于<span style="color: black;"><a style="color: black;">左心衰</a></span>而形成的全心衰。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，<span style="color: black;">因此呢</span>阵发性<span style="color: black;">呼气</span>困难等肺淤血症状反而有所减轻。<span style="color: black;"><a style="color: black;">扩张型心肌病</a></span>等表现为<span style="color: black;">上下</span>心室<span style="color: black;">同期</span><span style="color: black;">衰尽</span>者，<span style="color: black;"><a style="color: black;">肺淤血征</a></span><span style="color: black;">常常</span>不很严重，左心<span style="color: black;">衰尽</span>的表现<span style="color: black;">重点</span>为心排血量减少的<span style="color: black;">关联</span>症状和体征。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">2、</span><span style="color: black;"><a style="color: black;">慢性心力<span style="color: black;">衰尽</span></a></span><span style="color: black;">通常</span>治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、</span>减轻心脏负荷。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 1，<span style="color: black;">休憩</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 2，<span style="color: black;">掌控</span>钠盐摄入：减少钠盐的摄入，可减少<span style="color: black;">身体</span><span style="color: black;"><a style="color: black;">水潴留</a></span>，减轻心脏的前负荷，是治疗心力<span style="color: black;">衰尽</span>的<span style="color: black;">要紧</span><span style="color: black;">办法</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 3，<span style="color: black;"><a style="color: black;">利尿剂</a></span>的应用。常用利尿剂：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （1）噻嗪类：双氢克尿塞、<span style="color: black;"><a style="color: black;">氯噻酮</a></span>等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （2）袢利尿剂：速尿，<span style="color: black;"><a style="color: black;">利尿酸钠</a></span>，丁苯氧酸。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （3）<span style="color: black;"><a style="color: black;">保钾利尿剂</a></span>：安替舒通，氨苯喋啶。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （4）碳酸酐酶<span style="color: black;">控制</span>剂：<span style="color: black;"><a style="color: black;">醋氮酰胺</a></span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4，血管扩张剂的应用：血管扩张剂治疗心力<span style="color: black;">衰尽</span>的基本原理是<span style="color: black;">经过</span>减轻前或（和）后负荷来改善心脏功能。可为分；①静脉扩张剂，如<span style="color: black;"><a style="color: black;">硝酸甘油</a></span>和<span style="color: black;"><a style="color: black;">硝酸盐</a></span>类等；②小动脉扩张剂，如<span style="color: black;"><a style="color: black;">肼苯哒嗪</a></span>、敏乐啶等；③小动脉和静脉扩张剂，如硝普钠、酚妥拉明、<span style="color: black;"><a style="color: black;">哌唑嗪</a></span>、巯甲丙脯酸等。静脉扩张剂可减轻后负荷。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">2、</span>加强<span style="color: black;"><a style="color: black;">心肌收缩力</a></span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;"><a style="color: black;">洋地黄</a></span>类<span style="color: black;">药品</span>的应用：常用制剂：如毒毛旋花子甙K、G、西地兰、<span style="color: black;"><a style="color: black;">地高辛</a></span>、洋地黄叶、洋地黄毒甙等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">3、</span>其他治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1，有<span style="color: black;">呼气</span>困难者可给予吸氧。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 2，并发症及其治疗：心力<span style="color: black;">衰尽</span>时<span style="color: black;">平常</span>的并发症及其治疗如下：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （1）<span style="color: black;"><a style="color: black;"><span style="color: black;">呼气</span>道感染</a></span>：较<span style="color: black;">平常</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （2）血栓形成和栓塞。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> （3）<span style="color: black;"><a style="color: black;">电解质<span style="color: black;">错乱</span></a></span>。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">3、</span>心力<span style="color: black;">衰尽</span>后果是什么</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 慢性心力<span style="color: black;">衰尽</span>的<span style="color: black;">显现</span>，会<span style="color: black;">引起</span><span style="color: black;">病人</span>的肝脏，会<span style="color: black;">长时间</span>的<span style="color: black;">处在</span>淤血和缺氧的状态，这种<span style="color: black;">状况</span>容易<span style="color: black;">引起</span>干细胞萎缩、肝<span style="color: black;"><a style="color: black;">结缔组织</a></span>增生，从而还会<span style="color: black;">显现</span>肝硬化、脾大及大量腹水等，而腹水压力就会进一步恶化<span style="color: black;"><a style="color: black;">心肺功能</a></span>。这些都是慢性心力<span style="color: black;">衰尽</span><span style="color: black;">害处</span>，<span style="color: black;">认识</span>了这些相信<span style="color: black;">大众</span>就会好好的预防该病，<span style="color: black;">否则</span>该病给自己带来<span style="color: black;">损伤</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 在慢性心力<span style="color: black;">衰尽</span>治疗的过程中，会有一部分<span style="color: black;">病人</span><span style="color: black;">必须</span><span style="color: black;">长时间</span>的<span style="color: black;">吃下</span>利尿剂，因而容易<span style="color: black;">导致</span>低血钾、低钠<span style="color: black;">综合症</span>。<span style="color: black;"><a style="color: black;">低血钾症</a></span>轻者全身乏力，重者可<span style="color: black;">显现</span><span style="color: black;"><a style="color: black;">严重<span style="color: black;">心率</span>失常</a></span>;低钠<span style="color: black;">综合症</span>则轻者肌肉抽搐、重者<span style="color: black;">晕倒</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 心力<span style="color: black;">衰尽</span>的<span style="color: black;">显现</span>，会<span style="color: black;">引起</span><span style="color: black;">病人</span>的心脏负荷加重，<span style="color: black;">导致</span><span style="color: black;">呼气</span>困难，<span style="color: black;">同期</span>还会<span style="color: black;">伴同</span>有脚踝肿胀，容易感到疲劳<span style="color: black;">没</span>力等临床症状带来的<span style="color: black;">极重</span>痛苦，<span style="color: black;">况且</span>因反复住院，给病人及家属带来<span style="color: black;">许多</span>的<span style="color: black;">不方便</span>和沉重的<span style="color: black;">包袱</span>。随着病情的进一步发展恶化，心力<span style="color: black;">衰尽</span>还可能会诱发更严重的并发症，威胁健康。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心力<span style="color: black;">衰尽</span>在平时生活中<span style="color: black;">显现</span>，会<span style="color: black;">引起</span><span style="color: black;">病人</span>在大量利尿的<span style="color: black;">状况</span>下，<span style="color: black;">引起</span>血容量大过度降低，心排血量下降，血<span style="color: black;"><a style="color: black;">尿素氮</a></span><span style="color: black;">升高</span>。<span style="color: black;">病人</span>皮肤弹性减低，<span style="color: black;">显现</span>体位性低血压和少尿。间断利尿或<span style="color: black;">海量</span>利尿后<span style="color: black;">弥补</span>适量液体，可预防其<span style="color: black;">出现</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 心力<span style="color: black;">衰尽</span>属于危险性<span style="color: black;">疾患</span>，有发病率高、死亡率高的特点，<span style="color: black;">必定</span>要提早预防，减少心力<span style="color: black;">衰尽</span>的发病率。据<span style="color: black;"><a style="color: black;">流行病学调查</a></span>，全世界心衰发病率将近2%，美国心衰的患病率在1.5%-2%，大<span style="color: black;">大概</span>400万心衰<span style="color: black;">病人</span>，我国35-74岁成年人心衰患病率为0.9%，心衰<span style="color: black;">病人</span>达到360万，城市发病率高于农村，北方高于南方，女性高于男性，发病随年龄<span style="color: black;">增多</span>而<span style="color: black;">上升</span>，年死亡率为20%至50%,5年死亡率达67%。除<span style="color: black;">导致</span>死亡以外，心力<span style="color: black;">衰尽</span>可严重影响<span style="color: black;">病人</span>的生活质量，<span style="color: black;">乃至</span>生活<span style="color: black;">不可</span>自理，有人<span style="color: black;">叫作</span>心衰是"生命的绊脚石"。</p>
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