影响慢性心力衰竭患者再入院的因素分析

目的探讨影响慢性心力衰竭患者再入院的因素,寻找保护因素,为慢性心力衰竭缓解期患者的院外护理提供依据。方法对我科2003～2004年收治的心功能不全缓解期出院患者进行1年随访。结果55%患者于出院后3～6个月内再入院。患者的经济状况、药物治疗的依从性、饮食习惯(有无低钠限水)、前次入院的心功能状况、是否坚持适量运动等均对其再入院有影响。但未发现患者心理状态(抑郁)对慢性心力衰竭再入院有影响。结论加强药物治疗的依从性、养成良好的饮食习惯(低钠限水)、坚持适量运动能改善患者生活质量,减少其再入院次数。     

微量泵注射多巴胺和呋塞米治疗顽固性心力衰竭的护理

总结了微量泵注射多巴胺和呋塞米治疗顽固性心力衰竭的护理措施。主要包括吸氧、强心、扩血管、限水、卧床休息等治疗,及采用微量输液泵经外周静脉泵入多巴胺及呋塞米,加强饮食、尿量、微量泵的监管及护理。认为对顽固性心力衰竭患者用微量泵注射多巴胺和呋塞米治疗及精心护理,可提高疗效、改善预后。     

硝普钠联合多巴胺、硫酸镁治疗难治性心力衰竭的临床观察及护理

难治性心力衰竭是各种心脏病的一种危重合并症，临床特征复杂，治疗有效率低，死亡率高。我院1999年1月～2004年8月收治50例难治性心力衰竭患者，在给予卧床休息、限盐、纠正水、电解质、酸碱平衡紊乱、强心利尿的同时用硝普钠、多巴胺、硫酸镁治疗，加上有效合理的护理，效果满意。     

实用重症监护护理

心力衰竭患者的监护4心力衰竭的治疗心力衰竭的治疗原则是治疗心力衰竭的基本病因、除去诱发因素、减轻心脏负荷、增强心肌收缩力。4.1病因治疗治疗心力衰竭,应首先进行基本病因的治疗。4.2一般治疗4.2.1休息休息是心力衰竭的一种基本治疗方法,包括体力的休息和精神的放松。患者的活动方式及其持续时间应根据病情轻重及对治疗的反应来决定,严重者需绝对卧床休息2周以上。一般在心功能逐步改善的过程中,可适当下床活动。此外,应注意解除精神负担,必要时口服小剂量镇静剂,使患者更好地休息。4.2.2饮食限制钠盐及含钠食物的摄入,以减少水钠潴留…     

肾移植术后患者急性心力衰竭的观察和护理

目的探讨肾移植术后患者发生急性心力衰竭的高危因素及护理措施。方法回顾性分析肾移植患者发生心力衰竭的高危因素。术后通过对生命体征、CVP观察,定时进行出入量的评估,保持水和电解质平衡,合理调控血压等措施预防术后急性心力衰竭的发生。结果本组术后并发急性心力衰竭23例,经治疗和护理,症状缓解,无1例发生护理并发症。结论及时发现病情变化,准确评估补液量,控制血压对有效防治肾移植术后患者发生急性心力衰竭具有积极的意义。     

慢性心力衰竭伴稀释性低钠血症112例的治疗

对112例慢性心力衰竭伴稀释性低钠血症患者,除给予限水、扩张血管、强心治疗外,部分轻度低钠患者予食物补充氯化钠5 g/d,其余患者给予3%氯化钠静脉滴注及呋塞米静脉注射治疗.结果示经治疗后10日显效83例,有效19例,无效10例,总有效率91%.提示在适当补充钠盐的同时(包括应用3%的氯化钠静脉滴注或口服补钠)辅以呋塞米利尿不失为一种有效的治疗方法.     

中老年慢性心力衰竭并胸腔积液通过留置导管引流的疗效评估

目的 探讨中老年慢性心力衰竭并胸腔积液患者留置导管引流的疗效。方法 选取2019年6月—2020年6月丰台中西医结合医院收治的63例中老年慢性心力衰竭并胸腔积液住院患者为研究对象。按照随机数表法分为两组,对照组30例,观察组33例。对照组患者予限盐、限水、利尿等常规性治疗;观察组在此基础上,给予胸腔留置管持续引流,14 d后比两组治疗效果。结果 治疗后,观察组患者在减轻体质量、减慢心率、增加6 min步行试验距离、降低血BNP值以及减少胸腔积液最深水深方面均优于对照组,差异有统计学意义（P<0.05）;观察组住院时间为（11.70±1.78）d,明显短于对照组的（13.83±2.63）d,差异有统计学意义（t=6.236,P<0.05）。结论 在常规性治疗的基础上给予胸腔留置管引流处理治疗中老年慢性心力衰竭并胸腔积液患者,可以在短时间内安全地改善患者临床症状,缩短住院时间。     

血清CA125浓度改变对慢性心力衰竭患者临床诊治的价值

目的探讨慢性心力衰竭(CHF)患者血清中CA125浓度的改变与心力衰竭程度的关系和影响其浓度的相关因素,正确评价其临床意义。方法血清CA125测定:抽取2ml空腹时的静脉血,分离血清进行免疫放射分析法测定浓度。123例患者按照纽约心脏病学会心功能分级标准,分为Ⅱ、Ⅲ、Ⅳ级组。设对照组20例。按有无心源性胸水而分为有胸水组和无胸水组,并对治疗前后的CA125浓度作对比。结果CHF患者CA125血清浓度明显高于对照组(P<0.01),而且浓度的升高与心力衰竭的程度呈正相关。心源性胸水患者明显高于无心源性胸水患者。治疗后CA125的血清浓度随心衰好转而显著下降。结论CHF患者的CA125水平与左室射血分数(LVEF)值呈负相关,与心衰程度呈正相关;有心源性胸水者的CA125水平明显高于无心源性胸水者;CHF治疗后CA125水平显著下降。     

慢性心力衰竭急性加重的常见诱因及护理对策

通过对60例心力衰竭患者发病的诱发因素的分析,列出心力衰竭常见诱发因素包括感染、过度体力活动、生理性或情素压力、钠盐摄入过多,并给予预防感染、避免过度劳累、饮食指导、心理护理、控制过量的体液潴留、护理及遵嘱用药过程中注意事项以及其他相关宣教等护理对策,指导患者对慢性心力衰竭急性加重的诱发因素进行有效预防并积极配合治疗护理,可明显减少慢性心力衰竭患者的复发率和死亡率,提高患者的治疗和护理效果,最终提高患者的生活质量以及生命安全。     

酚妥拉明速尿联合治疗老年肺心病心力衰竭39例临床观察

酚妥拉明速尿联合治疗老年肺心病心力衰竭３９例临床观察福建省三明市第三医院（３６５００１）李星，林植馨我院自１９９１～１９９４年对７８例老年慢性肺源性心脏病心力衰竭住院患者，按临床常规给予休息、限盐、低流量给氧、抗生素控制感染及对症处理的基础上，治疗组...     

心力衰竭患者液体限制依从性的现状及影响因素研究

目的 调查心力衰竭患者液体限制依从性的现状,并分析其影响因素。方法 采用便利抽样法,选取2018年3月-2019年9月心内科收治的234例心力衰竭患者为研究对象,采用一般资料调查表、视觉模拟评分、液体限制依从性问卷、医院焦虑与抑郁量表对患者进行调查。结果 234例心力衰竭患者的液体限制依从率仅为31.6%。Logistic回归分析结果显示,口渴感、焦虑、抑郁是心力衰竭患者液体限制依从性的独立影响因素。结论 心力衰竭患者液体限制依从性亟待提高,患者口渴感强烈、焦虑、抑郁严重可显著降低其液体限制依从性。护理人员应结合相关影响因素,采取针对性的干预措施,提高患者液体限制依从性。     

Nutritional considerations in heart failure

There are a number of factors related to heart failure pathophysiology and treatment that influence nutrient requirements for patients. These include catabolism, inflammation, oxidative stress, diuretic use, and presence of comorbidities. On the other hand, there is evidence that specific nutrients can alter heart failure pathophysiology. This article reviews the current evidence for nutritional recommendations regarding sodium and fluid restriction, macro- and micronutrient intake, and dietary changes required by the presence of common comorbidities.     

Cultural implications of managing chronic illness: Treating elderly Chinese patients with heart failure

Dietary patterns are associated with morbidity and mortality of heart failure. Volume overload was the most common cause for re-hospitalization for heart failure patients. However, recommended preventive strategies of restricting excessive dietary sodium and fluid intake were found to be in vain. This study looks at the preventive dietary instructions from a cultural context, and examined the effects of sodium and fluid restriction on twelve elderly Chinese patients hospitalized with heart failure through a qualitative design. Four themes emerged from the data: medicine–food homology, salt and sodium as synonymous, activity intolerance but still wanting social connections, and barriers to asking questions. Results suggested that living with heart failure is a complex and changeable process for both patients and caregivers. Many patients reported low levels of understanding concerning their symptoms and heart function deterioration. The findings found that good communication requires cultural sensitivity, objective listening to the patient's narrative, and helping patients find meaning between their experiences and symptom control.     

Aggressive salt and water restriction in acutely decompensated heart failure: is it worth its weight in salt?

Evaluation of: Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern. Med. 173(12), 1058–1064 (2013).

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization worldwide, especially in the elderly, and is associated with a high readmission rate and increased first year mortality . Fluid overload manifested by pulmonary congestion is seen in the majority of patients with ADHF and is believed to be the reason behind most admissions. ADHF is commonly treated with intravenous diuretics aimed to alleviate congestion and restore euvolemia. In fact, current European and American guidelines for heart failure (HF) consider relief of congestion as the first-line therapy in ADHF. Following the same theme of reducing fluid retention, historical approaches have recommended water and salt restriction as an essential non-pharmacological therapy in the management of symptomatic HF. This ‘common sense’ dietary practice was mainly based on experts’ opinions and has been challenged by recent data suggesting that salt or fluid restriction has neutral outcomes in achieving clinical stability and improving signs and symptoms of HF .     

Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care.

BACKGROUND: Improved self-care behaviour is a goal in educational programmes for patients with heart failure, especially in regard to daily self-weighing and salt and fluid restriction. AIMS: The objectives of the present study were to: (1) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care, during one year of monthly telephone follow-up after a single session education, (2) to describe gender differences in regard to self-care and (3) to investigate if self-care was associated with health-related quality of life. METHODS: The present analysis is a subgroup analysis of a larger randomised trial. After one intensive educational session, a primary health care nurse evaluated 60 patients (mean age 79 years, 52% males, 60% in New York Heart Association class III-IV) by monthly telephone follow-up during 12 months. RESULTS: The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour. Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period. No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months. CONCLUSION: The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients.     

Impact of patient education on self-care behaviour in patients with heart failure: a review of the literature

Heart failure is a highly prevalent chronic condition. Nurse-led patient education has been described in the literature as a key component of disease management programs. This literature review investigates the impact of patient education on self-care behaviour in patients with heart failure. Seven randomised controlled trials could be included in the review. Medication taking, daily weighing, salt and fluid restriction and taking action in case of worsening symptoms are cornerstones in patient education programs. All seven studies revealed that interventions comprising patient education were associated with improved self-care behaviour in patients with heart failure. The education has to be individualized and family members should be included. Nurses play an important role in patient education interventions and must be well trained and skilled for example in clinical assessment. To date, the dose and the length of the patient education interventions necessary to improve self-care behaviour and sustain these behaviours remain unclear and need more research.     

Practical management of chronic renal failure.

Initial evaluation of patients with chronic renal failure demands a careful search to exclude reversible causes such as dehydration, obstruction and nephrotoxins. Subsequently, strict management of sodium and fluid intake is necessary to avoid either dehydration or congestive heart failure. As renal failure advances, restriction of dietary protein and potassium and binding of phosphate are indicated. Referral to an end-stage renal disease center should be accomplished early, before and appearance of uremic symptoms, to facilitate a smooth transfer to the next phase of rehabilitative therapy.     

社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平现状调查

[目的]了解社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平及其影响因素。[方法]采用一般资料调查表和亚特兰大心力衰竭知识问卷对155例社区慢性心力衰竭病人家庭照顾者进行调查。[结果]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识得分为17.66分±3.98分;得分低水平者(答对率低于60%)占43.9%;照顾者答对率后5个条目为低盐饮食的标准、液体摄入量的控制方法、身体疼痛时非处方药的选择、接种流感、肺炎疫苗以及监测体重的频率;不同文化程度的照顾者其心力衰竭知识得分差异有统计学意义(P<0.05),文化程度越低者相关知识得分越低。[结论]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识水平处于低水平,医护人员进行健康教育时,应注意评估教育对象的接受能力并采取个体化、持续性的健康教育,以提高其相关知识水平。