急性心力衰竭的治疗现况

急性心力衰竭(AHF)是由于心功能异常导致症状和体征急性发作的临床综合征,病情进展快、预后差。除一般紧急处理外,及时有效的药物治疗和准确熟练的外科手术对挽救患者生命至关重要,本文对近年来急性心力衰竭的治疗进展作一综述。     

急性心力衰竭的病因和临床评价

急性心力衰竭（acute heart failure，AHF）指由于急性发作的心功能异常而导致的以肺水肿、心源性休克为典型表现的临床综合征。发病前可以有或没有基础心脏病史，可以是收缩性或舒张性心力衰竭，起病突然或在原有慢性心力衰竭基础上急性加重。AHF通常危及患者的生命，必须紧急实施抢救和治疗。     

急性心力衰竭的现状及治疗进展

急性心力衰竭已成为威胁人类健康迫切需要解决的大问题,住院率及病死率均较高。近年来,在传统药物基础上新型正性肌力药物左西孟旦、新型血管扩张剂奈西利肽及血管加压素拮抗剂托伐普坦能有效改善患者的血流动力学及充血症状,可能为急性心力衰竭患者带来新的希望;非药物治疗方面无创通气、左室辅助装置及超级滤过装置正成为药物治疗的有益补充。     

急性心力衰竭的诊断和处理原则

急性心力衰竭（acute heart failure, AHF）指由于急性发作的心功能异常而导致的以肺水肿、心原性休克为典型表现的临床综合征。发病前可以有或无基础心脏病史，可以是收缩性或舒张性心力衰竭，起病突然或在原有慢性心力衰竭基础上急性加重。AHF通常危及患的生命，必须紧急实施抢救和治疗。     

急性心力衰竭综合征诊疗新进展

急性心力衰竭综合征发生率逐年增多且预后不良,严重威胁人类健康.临床上虽极受重视,但一直缺乏有说服力的循证医学研究证据.近年来开展的一些大系列登记研究发现,急性心力衰竭综合征在流行病学、预后及治疗上与经典观念有很大差别.现对此做一简单阐述,并就一些新的相关观念作简单介绍.     

急性心力衰竭诊断和治疗展望

心力衰竭作为心血管事件链的下游是21世纪心血管疾病治疗的最后战场,急性心力衰竭常危及生命,必须紧急施救和治疗。N端-脑钠肽前体是鉴别急性心力衰竭与其他原因所致呼吸困难的重要指标,和超敏C反应蛋白、肌钙蛋白与急性心力衰竭的程度、预后密切相关。奈西立肽、左西孟旦、托伐普坦、rolofylline等为急性心力衰竭的药物治疗带来前景,急性心力衰竭的非药物治疗将成为药物治疗的有效伴随手段。全方位多层次的防治是降低急性心力衰竭再住院率、病死率的重要方式。     

人参子注射液对维拉帕米致犬急性心力衰竭心功能的影响

目的：观察人参子注射液对急性心力衰竭犬心功能的影响。方法：采用健康杂种犬静脉输注维拉帕米（异搏定）造成急性心力衰竭动物模型。静脉给予不同剂量的人参子注射液，观察用药前后左心室内压上升最大速率（dp/dtmax)。左心室舒张终末压（LVEDP）及心排血量（CO）的变化。结果：各组造模后dp/dt-max,CO均明显下降，LVEDP升高，用人参子注射液治疗后即刻dp/dtmax虽有所下降，但随后逐渐回升，LVEDP下降，CO增加。结论：人参子注射液可明显降低心脏前负荷，改善心脏的收缩功能。增加心输出量。     

强化极化液治疗急性心力衰竭临床观察

强化极化液治疗急性心力衰竭临床观察陈俊秀广东汕头市龙湖区人民医院内科（５１５０４１）为探讨强化极化液对急性心力衰竭（心衰）的治疗价值，本文选择１９８４～１９９２年住院诊治的急性心衰９０例，对比观察了４７例在常规强心、利尿治疗基础上加用强化极化液的治疗...     

急性心力衰竭诊断和治疗的相关热点研究

急性心力衰竭(AHF)继发于异常心脏功能,迅速发生症状和体征,常危及生命,需要紧急治疗.AHF可以是急性起病(先前不知有心功能不全的病史)亦或是慢性心力衰竭急性失代偿,其中慢性心力衰竭急性失代偿更为多见.AHF与收缩性或舒张性功能不全有关,也与心脏节律异常或前后负荷不匹配有关.     

米力农治疗慢性心力衰竭急性加重期90例疗效观察

目的 观察米力农治疗慢性心力衰竭急性加重期的临床疗效.方法 选择慢性心力衰竭急性加重期病人180例,随机分为治疗组与对照组各90例.对照组予常规控制心力衰竭治疗(利尿、扩血管、改善心室重构等);治疗组在此基础上加用米力农,微量泵泵入0.375μg/(kg·min)持续泵入72 h.观察两组临床疗效,心功能指标,记录不良反应.结果 治疗组治疗后心功能有明显改善,左宣射血分数提高.且临床总有效率为94.5%,明显优于对照组的70.0%(P<0.05).治疗过程中未见明显不良反应.结论 米力农治疗慢性心力衰竭急性加重期安全有效.     

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进入新千年以来,急性心力衰竭成为一个令人关注的临床热点,相继有EHF1、ADHERE、EHF2三个大规模的临床研究的公布及ESC急性心力衰竭治疗指南的推出.     

Treatment of heart failure

Kjekshus J, Swedberg K (Department of Medicine, The National Hospital, University of Oslo, Oslo, Norway, and Department of Medicine, Östra University Hospital, Göteborg University, Göteborg, Sweden). Treatment of heart failure (Minisymposium: Heart failure). J Intern Med 1996; 239: 335–43.
Effective treatment of heart failure depends on a correct functional and aetiological diagnosis. In asymptomatic patients with cardiac dysfunction following myocardial infarction, treatment is directed to prevent recurrent infarction by aggressive lipid lowering with statins and antiplatelet drugs. Beta blockers are important to reduce sudden death. In symptomatic heart failure, clinical improvement is obtained by inhibition of the renin–angiotensin and sympathetic system. Angiotensin-converting-enzyme inhibitors in combination with diuretics reduce morbidity and mortality caused by progression of the myocardial dysfunction and recurrent myocardial infarction. Drugs that activate the neurohormonal systems are clearly counteractive. Digitalis has a definite favourable effect on systems, and in patients with atrial fibrillation, but its effect on mortality is still unsettled. Beta blockers in routine treatment of symptomatic heart failure still remains controversial, but may benefit selected patients.     

Treatment of acute profound heart failure by ventricular assist device.

Sixteen patients with acute profound heart failure (HF) have been treated with the left ventricular assist device (LVAD), nine of them were successfully weaned from LVAD, and three of them were discharged and survived longer. Decompression of the left ventricle (LV) at the beginning will prevent overextension of impaired myocardium and accelerate scar formation. Gradual increase of LV work will promote the compensation ability of the residual myocardium. We found that continuous LVAD assistance can give time for the impaired heart to recover while maintaining normal circulation. For patients with profound HF which is beyond the limit of intra-aortic balloon pumping's (IABP) capability, LVAD is a more powerful and effective means. Although the heart recovered, many patients later died of multiple organ failure (MOF) which was probably caused by prolonged ischemia before LVAD application. For completely successful recovery from profound HF, diagnosis and deciding to use LVAD should not be delayed. It should be applied before major organs including the heart itself suffer irreversible damage. We have established a systematic therapeutic concept of treating acute HF patients using assisted circulation including LVAD.     

急性心力衰竭综合病因评分预计死亡率研究

目的 探讨急性心力衰竭病因评分在急性心力衰竭疾病中的应用价值.方法 采用APACHEⅡ评分、心力衰竭基础病因及诱因综合评分,在此评分基础上对42 例急性心力衰竭患者预计死亡率进行评估并建立预计死亡率模型,分层计算群体预计死亡率.结果 根据急性心力衰竭病因评分分值进行分组,随着分值逐渐升高,实际病死率和预计死亡率也逐渐升高,死亡组评分均值显著高于生存组(P＜0.05).结论 急性心力衰竭病因评分系统简易实用,可用于院前急救及急诊急性心力衰竭患者初步评估.     

顽固性心力衰竭的治疗

顽固性心力衰竭 ,又称难治性心力衰竭 (ｒｅｆｒａｃ ｔｏｒｙｈｅａｒｔｆａｉｌｕｒｅ ,ＲＨＦ)是指心力衰竭经常规治疗 ,包括去除诱因、休息、氧疗、限盐、强心、利尿、扩张血管等措施而效果较差 ,症状持续存在的情况 ,是长期以来困扰医学界的难题。临床上 ,这类心力衰竭大多存在特异的原因或诱因。因此 ,治疗上除了遵循一般的心衰治疗原则以外 ,须特别注意 :1　消除可克服的病因及诱因随着技术的进步、治疗手段的日益增多和改进 ,有些器质性心脏病目前已能进行病因治疗。因此 ,如果心力衰竭的病因是某些先天性心脏病、心瓣膜病、心包疾…     

Treatment of advanced heart failure

The incidence of chronic heart failure has increased, with a corresponding increase in morbidity and mortality, and has made a substantial financial impact on our society. Improved therapy for heart failure has resulted in a significant prolongation of survival, a decreased number of hospitalizations, and an enhanced quality of life for many patients. It can reasonably be expected, therefore, that adherence to a rational medical regimen for these patients might decrease costs as well. Management of patients with severe heart failure begins with identifying the etiology and educating the patients and their families. Angiotensin-converting enzyme inhibitors are the cornerstone of therapy but only after diagnostic tests are performed to establish the etiology and extent of myocardial dysfunction. Because cardiac transplantation is a therapeutic option for only a limited number of patients, other surgical and medical therapies have to be viewed as the mainstay of a treatment strategy.