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6hz7vif 发表于 2024-6-7 23:42:46

急性左心衰竭

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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">前言</strong></span><span style="color: black;">｜</span><span style="color: black;">Foreword</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性左心衰竭是<span style="color: black;">平常</span>的一种紧急临床<span style="color: black;">情况</span>，<span style="color: black;">倘若</span><span style="color: black;">无</span><span style="color: black;">即时</span>处理，<span style="color: black;">或</span><span style="color: black;">无</span><span style="color: black;">即时</span>识别和诊断处理，病人很容易<span style="color: black;">显现</span>死亡，是一个死亡率比较高的临床综合病症。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7Lc5FZ5biavmtwySMiaNHPOYmwT8Gl2tClSvYO26EoHwWWxq4iadXgBIAA/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;"><span style="color: black;">关联</span>定义及概念</span></strong></p><span style="color: black;">急性左心衰竭的定义，<span style="color: black;">便是</span>心肌急性<span style="color: black;">爆发</span>，<span style="color: black;">或</span>急性加重的心肌收缩，心肌收缩率<span style="color: black;">忽然</span>下降，<span style="color: black;">或</span>舒张功能受限，<span style="color: black;">引起</span>肺循环肺血管压力急剧<span style="color: black;">上升</span>和外周血管阻力的<span style="color: black;">增多</span>产生的肺水肿，严重时<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">引起</span>心源性休克<span style="color: black;">出现</span>。</span><span style="color: black;">急性左心衰竭<span style="color: black;">包含</span>了几方面：急性<span style="color: black;">爆发</span>，<span style="color: black;">另一</span><span style="color: black;">便是</span><span style="color: black;">能够</span>在慢性心衰的<span style="color: black;">基本</span>上，加重病情，<span style="color: black;">或</span>某些诱发<span style="color: black;">原因</span>诱导<span style="color: black;">显现</span>了，<span style="color: black;">因此</span>临床上<span style="color: black;">亦</span><span style="color: black;">按照</span>这些<span style="color: black;">能够</span>分成不同的心衰，有<span style="color: black;">保存</span>摄血分数的心衰，<span style="color: black;">亦</span>有摄血分数下降的左心衰。</span><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7lJc3pYDgU1lxO4awZk6RvgFU4nia030puLulx63dXicGuLs6XHa34DtQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">急性左心衰的发病过程，<span style="color: black;">实质</span>上受到神经内分泌的调节，以及炎症反应的过程，在这个过程中，<span style="color: black;">没</span>论是新发的心衰<span style="color: black;">或</span>慢性心衰，总有<span style="color: black;">各样</span>各样的诱发<span style="color: black;">原因</span>，<span style="color: black;">因此</span><span style="color: black;">引起</span>心脏心肌的功能<span style="color: black;">阻碍</span>。<span style="color: black;">这儿</span>面既有心肌收缩的问题，有舒张的问题，<span style="color: black;">一般</span>这些急性左心衰，<span style="color: black;">出现</span>到这一步以后，最后就会<span style="color: black;">显现</span>肺循环淤血的<span style="color: black;">状况</span>，<span style="color: black;">引起</span>右心衰，从而<span style="color: black;">显现</span>全身充血。</span></span><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7bcG2DWvCcyDrnG6ibg9FhaPrTUyhPd1nIaTS5BPMdiaQjIh8qu3zeF9A/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;">流行病学</span></strong></p><span style="color: black;"><span style="color: black;">在<span style="color: black;">全世界</span>范围内，院内急性心力衰竭死亡率徘徊在4%，出院后60至90天内<span style="color: black;">提升</span>至10%，1年后进一步<span style="color: black;">增多</span>到25-30%。</span></span><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7JJU068ibd9yaibicEvwdvxf4PlOFkzFqXuBEoH2lNw257lfDT6EpDDNtQ/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;">分&nbsp; &nbsp;类</span></strong></p><span style="color: black;">新发心衰的<span style="color: black;">平常</span>病<span style="color: black;">由于</span>急性心肌坏死和（或）<span style="color: black;">损害</span>（如急性冠状动脉<span style="color: black;">综合症</span>、重症心肌炎等）和急性血流动力学<span style="color: black;">阻碍</span>（如急性瓣膜关闭不全、高血压危象、心脏压塞)。</span><span style="color: black;">慢性心衰急性失代偿常有1个或多个诱因，如血压<span style="color: black;">明显</span><span style="color: black;">上升</span>、ACS、<span style="color: black;">心率</span>失常、感染、治疗依从性差、急性肺栓塞、贫血、COPD急性加重、围术期、肾功能恶化、甲状腺功能<span style="color: black;">反常</span>、<span style="color: black;">药品</span>（如非甾体抗炎药、皮质激素、负性肌力<span style="color: black;">药品</span>）以及静脉输入液体（尤其是含钠液体）<span style="color: black;">太多</span>过快等。</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Factors triggering acute heart failure</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7SzcwLYvatd1QmS0E8lwclOxU6xvW8k8PmDVdjQuXibWbcTNLC7hJDeg/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;">临床表现</span></strong></p><span style="color: black;">急性心力衰竭的临床表现以肺淤血/肺水肿、体循环淤血以及低心排血量（低血压、心脏指数CI≤2.2L/(min*m2)和组织器官低灌注（四肢皮肤湿冷、少尿[尿量&lt;0.5mL/(<span style="color: black;">公斤</span>*h)]、<span style="color: black;">认识</span>模糊、<span style="color: black;">头昏</span>、血乳酸<span style="color: black;">上升</span>、肝功能<span style="color: black;">反常</span>、血肌酐水平<span style="color: black;">上升</span>≥1倍或肾小球滤过率下降&gt;50%)为特征，严重者并发急性<span style="color: black;">呼气</span>衰竭、心源性休克。</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">评&nbsp; &nbsp;估</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性心衰的诊断，在2021年欧洲指南中<span style="color: black;">重点</span>是<span style="color: black;">按照</span>病人的病史、症状、起病过程等，经过<span style="color: black;">有些</span><span style="color: black;">检测</span>，尤其<span style="color: black;">此刻</span>是床旁超声，<span style="color: black;">包含</span>心脏、肺超声，以及血氧饱和度是ICU基本的一个监测参数。心电图的<span style="color: black;">状况</span>，初始的实验室<span style="color: black;">检测</span>，其实初始的实验室检查项目应该<span style="color: black;">包含</span>前面所说的诱发<span style="color: black;">原因</span>，去甄别这些诱发<span style="color: black;">原因</span>，<span style="color: black;">因此</span><span style="color: black;">这儿</span>面可能<span style="color: black;">包含</span>内分泌的<span style="color: black;">检测</span>，<span style="color: black;">例如</span>甲状腺功能、肾上腺功能的<span style="color: black;">评定</span>。<span style="color: black;">另一</span>，有<span style="color: black;">无</span>感染，PCT<span style="color: black;">可否</span><span style="color: black;">上升</span>等等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性<span style="color: black;">爆发</span>的凶险并发症，可能越<span style="color: black;">初期</span>处理越好，<span style="color: black;">另一</span>，比较<span style="color: black;">敏锐</span>的生物学指标，<span style="color: black;">例如</span>脑钠肽这一类指标的监测，在指南上<span style="color: black;">亦</span>都给出相应的指标，<span style="color: black;">能够</span>供<span style="color: black;">咱们</span>去诊断和排除急性心衰。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7rfjHRAQeJibfbX9mgAaux57cKhwTRU0U8CF3T6MFDjRia6BMsISLNJibg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_svg/vDwntJFbiafuJr2QHVs3QjCZOtlkt0nxyXSbqcrwUkmqw07SFmibIE8xLpHlcoCIXBPUPicfqcbEGJiaYPCF2aic05neicNTQFcAuC/640?wx_fmt=svg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">不仅如此，还有<span style="color: black;">按照</span>病人的年龄，做出<span style="color: black;">关联</span>判断：</span></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">55岁以下，NT-proBNP&gt;450 ng/L</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">55~75岁，NT-proBNP&gt; 900 ng/L</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">75岁， NT-proBNP&gt; 1800 ng/L</span></p><span style="color: black;">肾功能不全（肾小球滤过率&lt;60mL/min)时NT-proBNP &gt; 1200 ng /L；伴有心房颤动的<span style="color: black;">病人</span>，<span style="color: black;">亦</span>宜将NT-proBNP界值<span style="color: black;">加强</span>20-30%。</span><span style="color: black;">在监测和<span style="color: black;">指点</span>心衰治疗方面，经各项治疗后利钠肽水平较基线值<span style="color: black;">显著</span>下降，即NT-proBNP较基线值降幅≥30%或绝对值&lt;4000pg/ml；BNP较基线值降幅&gt;50%或绝对值&lt;350~400pg/ml，提示治疗有效。</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">AHF的<span style="color: black;">关联</span>临床表现</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在不同的类型里，发病机制的差异会<span style="color: black;">引起</span>临床症状不太<span style="color: black;">同样</span>，<span style="color: black;">包含</span>血流动力学特点<span style="color: black;">亦</span>不是千篇一律的。在治疗上，尽管不同的心衰可能采用的<span style="color: black;">办法</span>不<span style="color: black;">同样</span>，<span style="color: black;">然则</span>利尿剂是治疗的基石，基本上任何心衰可能都<span style="color: black;">必须</span>用到利尿剂，除了心源性休克利尿剂<span style="color: black;">运用</span><span style="color: black;">必须</span><span style="color: black;">重视</span>。对疑诊心衰的处理，<span style="color: black;">重点</span><span style="color: black;">需求</span><span style="color: black;">咱们</span>甄别好诱发病因，<span style="color: black;">即时</span>去除病因，<span style="color: black;">另一</span>在<span style="color: black;">第1</span><span style="color: black;">周期</span><span style="color: black;">救治</span>性治疗，<span style="color: black;">包含</span>病人<span style="color: black;">倘若</span>缺氧，可能<span style="color: black;">必须</span>机械通气治疗，<span style="color: black;">乃至</span>紧急<span style="color: black;">状况</span><span style="color: black;">必须</span>机械辅助心脏的支持。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN76kibl73MF5056kQKehQsicvPuC6gATaMh0KIB2icQnwkTMKYqMEkMDlGQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_svg/vDwntJFbiafuJr2QHVs3QjCZOtlkt0nxyXSbqcrwUkmqw07SFmibIE8xLpHlcoCIXBPUPicfqcbEGJiaYPCF2aic05neicNTQFcAuC/640?wx_fmt=svg&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;">疑诊AHF的处理</span></strong></p><span style="color: black;"><span style="color: black;">甄别它的诱因，找出诱因后做相应的处理，<span style="color: black;">或</span>排除以后，<span style="color: black;">亦</span>应该进一步从其他方面进行治疗。</span></span><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7JPR68hMyw8JQeBcz48AZhEq5yMds5D7UACd5PpticOg5Vs0TMicH6kSw/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;"><span style="color: black;"><strong style="color: blue;">治&nbsp; &nbsp;疗</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">不同的分型对治疗<span style="color: black;">亦</span>是有影响的，如下图病人大致分为冷暖<span style="color: black;">或</span>干湿，组合起来有4种类型，这些类型箭头越往下说明灌注越差，横向箭头提示越往右淤血<span style="color: black;">情况</span>越严重。它的处理，就有所差别。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7icyAPnzeQotajIqICKRAxjQyg4lIyrkeAgdZfxet5wVdyjVRwjydd7A/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;"><span style="color: black;"><strong style="color: blue;">ADHF处理流程</strong></span><span style="color: black;">/process/</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7R1DT2tVqcWsG0e7HwKq3DnwCCc8senmUiaAHSWDa7kJv2QFePnn4LSA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">第1</span>步判断病人<span style="color: black;">可否</span>存在低灌注的<span style="color: black;">状况</span>，<span style="color: black;">倘若</span><span style="color: black;">无</span><span style="color: black;">显现</span>低灌注，利尿剂<span style="color: black;">便是</span>它的治疗基石，<span style="color: black;">因此</span>说利尿剂非常<span style="color: black;">要紧</span>。<span style="color: black;">倘若</span>合并心功能<span style="color: black;">欠好</span>，可能还<span style="color: black;">必须</span>一个心肌便利药，让低灌注得到缓解再进行相应的治疗，<span style="color: black;">或</span>治疗效果<span style="color: black;">欠好</span>，<span style="color: black;">亦</span>要<span style="color: black;">思虑</span>机械辅助。<span style="color: black;">倘若</span><span style="color: black;">无</span>低灌注<span style="color: black;">状况</span>，相应治疗<span style="color: black;">重点</span>是以利尿剂为主的治疗，<span style="color: black;">亦</span><span style="color: black;">便是</span>说容量过高，<span style="color: black;">重点</span>是减轻心脏的负荷。</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">急性肺水肿处理流程</strong></span><span style="color: black;">/process/</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7ZljTFlib3ibBODpXBoGVvvibPogDDYmmj6e8pRbxAkMsEvycFfs1jIvbg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">显现</span>了低氧<span style="color: black;">状况</span>要给氧，<span style="color: black;">然则</span>强调一点，在心衰时<span style="color: black;">倘若</span>病人<span style="color: black;">无</span><span style="color: black;">显现</span>低氧，就<span style="color: black;">不该</span>该<span style="color: black;">茫然</span>给氧，尤其是给高浓度的氧。高浓度的氧反过来可能会对冠状血管产生收缩作用，反而会恶化临床症状。<span style="color: black;">因此</span>，<span style="color: black;">仅有</span><span style="color: black;">知道</span>缺氧了，才是给氧的一个指征。这几年来<span style="color: black;">始终</span><span style="color: black;">亦</span>在说<span style="color: black;">严重</span>病人，<span style="color: black;">咱们</span><span style="color: black;">必须</span>保守性的氧疗，<span style="color: black;">便是</span><span style="color: black;">由于</span>对这些病理生理有了<span style="color: black;">有些</span>新的认识。</span></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">右心衰竭处理流程</strong></span><span style="color: black;">/process/</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7YuBRr9cjKev2JryyEQewkW04tupcOAETddRQ906YPFyJibDlkWmibRRA/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;"><span style="color: black;"><strong style="color: blue;">心源性休克处理流程</strong></span><span style="color: black;">/process/</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7Sg2ND2CNES4jt0bYdIlkiaFboAls81Hq2ZdoDbcfHlq2PHtsCgu9qMA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">心源性休克处理，<span style="color: black;">首要</span><span style="color: black;">思虑</span>的是要清理存在的心梗，<span style="color: black;">或</span>有机械性的并发症，<span style="color: black;">例如</span>瓣膜<span style="color: black;">显现</span>问题，这些可能<span style="color: black;">必须</span>介入<span style="color: black;">或</span>外科的<span style="color: black;">有些</span>治疗，其他的从ICU<span style="color: black;">方向</span><span style="color: black;">来讲</span>，血管怎么样<span style="color: black;">守护</span>好循环灌注，怎么样<span style="color: black;">提高</span>血压，来改善灌注和器官<span style="color: black;">损害</span>的<span style="color: black;">状况</span>。<span style="color: black;">倘若</span>说最后这些手段和保守治疗效果都<span style="color: black;">欠好</span>，<span style="color: black;">那样</span><span style="color: black;">亦</span><span style="color: black;">思虑</span>机械辅助<span style="color: black;">或</span>CRT治疗。</span></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.<strong style="color: blue;">Diuretics</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.<strong style="color: blue;">Vasodilators</strong>(nitrates or nitroprusside)</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7aZAQAia37gic6PMN6vwaQLKq4hgZl6G7fsePHZokmY0K1jh1RxPqQibdw/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">3.<strong style="color: blue;">Inotropes</strong>(Levosimendan,type-3-phosphodiesterase&nbsp; inhibitors，dobutamine)</span><span style="color: black;">4.<strong style="color: blue;">Vasopressors</strong></span><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7LXpBwOMgBsawBXmBMLjSuich5czK5HdbMlA5iaNoicpR3BEHibxlN826fg/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;">5.<strong style="color: blue;">Opiates</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6.<strong style="color: blue;">Digoxin</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">7.<strong style="color: blue;">Thromboembolism prophylaxis</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7bCpnutQLqia5NnHuN3PTGJ7IR8WSzTbBvibUf8afW2eppSqJl66YAiaHg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN77iaDgdicPPM4tIFwUbRibFKwtCYFdibtEJQib64jdAWqSfkibbwt4iaXUJ6PA/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;">Key poin</strong><strong style="color: blue;">t</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wkz2JVicHiawE1I1urOlJFoJQTYLw0vnN7naIG9dhTPWK3qSM4RvUsNuiaQ2ShDKcicib1CGplqErGQuomm84m6FURw/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">临床上常规的治疗<span style="color: black;">办法</span>，并且<span style="color: black;">供给</span>了一个<span style="color: black;">所说</span>的循证医学证据。其实<span style="color: black;">第1</span>步<span style="color: black;">便是</span>氧疗和机械通气的支持，<span style="color: black;">仅有</span>在低氧的<span style="color: black;">状况</span>下，才<span style="color: black;">必须</span>给病人进行氧疗来纠正低氧血症，<span style="color: black;">同期</span>尽早采用直接通气辅助<span style="color: black;">呼气</span>，<span style="color: black;">初期</span>可能在应急<span style="color: black;">状况</span>下先给一个<span style="color: black;">没</span>创，<span style="color: black;">倘若</span>效果<span style="color: black;">欠好</span><span style="color: black;">必定</span>要<span style="color: black;">即时</span>改成气管插管进行有创通气。</span><span style="color: black;"><span style="color: black;">针对</span>利尿剂的<span style="color: black;">运用</span>，<span style="color: black;">大众</span>可能比较熟了，还有血管扩张剂的应用，在指南上都有<span style="color: black;">有些</span><span style="color: black;">详细</span>的<span style="color: black;">指点</span>。</span><span style="color: black;">血管收缩剂的应用，<span style="color: black;">重点</span>在心源性休克时去用，<span style="color: black;">倘若</span>仅仅是肺水肿时，有时可能<span style="color: black;">更加多</span>的是利尿，就能够把病人血压<span style="color: black;">提高</span>，体液平衡、血容量处理好。</span><span style="color: black;">其他，如抗凝，这些<span style="color: black;">重点</span>用低分子肝素。<span style="color: black;">针对</span>机械辅助<span style="color: black;">安装</span>的应用，<span style="color: black;">咱们</span><span style="color: black;">无</span>什么经验，<span style="color: black;">况且</span>在临床上现有的<span style="color: black;">前提</span><span style="color: black;">亦</span>用的并不多，<span style="color: black;">更加多</span>还是停留在理论上。</span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">文献</span></p><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 style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Nat Rev Dis Primers 6,17 (2020)</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Eur J Heart Fail.2017.19(10).1242-1254</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Eur Heart J, 2021, 42(36), 3599-3726</span></p><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 style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">专家简介</strong></span></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;"><a style="color: black;"><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;"></a></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>

听听海 发表于 2024-8-22 10:53:42

谷歌外链发布 http://www.fok120.com/

364463952 发表于 2024-9-9 01:20:22

外贸B2B平台有哪些？

b1gc8v 发表于 2024-10-8 21:16:20

期待楼主的下一次分享！”

1fy07h 发表于 前天 09:05

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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