个体化护理干预对慢性充血性心力衰竭病人远期疗效的影响

慢性充血性心力衰竭(CHF)是一种复杂的临床症候群,是各种心脏病的终末阶段,其预后差、病死率高。目前,在临床上仅对病人进行药物治疗及卧床休息已不能达到预期的治疗目的,而对病人采取积极的个体化护理干预措施越来越值得重视。笔者对CHF病人采取护理干预治疗,现将结果报告如下。1资料与方法1.1一般资料选择我院心内科2008年5月—2010年3月住     

倍他乐克对扩张型心肌病充血性心力衰竭远期效果疗效观察

目的观察倍他乐克对扩张型心肌病充血性心力衰竭远期效果。方法对扩张型心肌病心功能Ⅱ。Ⅲ级门诊、住院患者72例，随机分组，治疗组与对照组各36例，对照组常规口服洋地黄制剂、利尿剂、转换酶抑制剂(ACEI)，治疗组在对照组基础上，加用倍他乐克3．25～25mg，2次，d，口服，住院期间停服倍他乐克，心功能恢复至Ⅲ级后，继续口服，由固定医师随访1次，2月，观察住院率、生活质量、死亡率。结果治疗组住院率36．1％，优于对照组77．8％；运动耐力积分率治疗组71.4％，对照组42．8％；死亡率治疗组22．5％，对照组47．2％(各组间率比较均P＜0．05)。结论倍他乐克能使扩张型心肌患者住院率、死亡率下降，运动耐力增加。生活质量提高。     

开搏通治疗充血性心力衰竭疗效观察

血管紧张素转换酶抑制剂(ACEI)治疗充血性心力衰竭(CHF)，近年来在临床上得到极大地重视。本文采取分组对比的方法以观察开搏通治疗充血性心力衰竭的疗效。     

蒙诺治疗慢性充血性心力衰竭疗效观察

我院自2002年1月～2005年1月对92例慢性充血性心力衰竭（CHF）患者用蒙诺（福辛普利钠片）治疗、疗效较好，现将结果报道如下：     

心血通治疗充血性心力衰竭疗效观察

心血通是近几年来应用高科技手段从哺乳类动物心肌人工提取的生物制剂,其主要成份为心钠素（ＡＮＰ）、降钙素基因相关肽（ＣＧＲＰ）、腺苷等具有利钠、排尿、扩张血管作用的抗心衰新药。近一年来我们通过静脉滴注心血通治疗２８例充血性心力衰竭（ＣＨＦ）患者,取得一定疗效,现报告如下。１　资料与方法１－１　病例选择　２８例ＣＨＦ患者均为经用洋地黄、利尿剂及血管扩张剂（口服）治疗２周以上,症状无明显改善者,男１９例,女９例,年龄３０～６９岁（平均５１±１３岁）。其中缺血性心肌病１１例,风心病（超声证实为二尖瓣狭…     

卡维地洛治疗慢性充血性心力衰竭疗效观察

目的 探讨卡维地洛在慢性充血性心力衰竭（CHF）中的疗效。方法 将48例CHF患者随机分为治疗组（A组）和对照组（B组）,各24例。B组予血管紧张素转移酶抑制剂（ACEI）、利尿剂和洋地黄制剂,A组在此基础上加用卡维地洛,随访6个月。对照观察治疗前后超声心动图、静息时心率、6min步行试验等以判断疗效。结果 治疗后心功能各项指标A组均优于B组（P〈0．01）。结论 卡洛地洛治疗CHF有显著疗效。     

不同剂量卡维地洛治疗充血性心力衰竭疗效观察

62例充血性心力衰竭患者随机分为两组:低剂量组在常规心衰治疗基础上加卡维地洛2.5mg,b id;高剂量组在常规心衰治疗基础上加卡维地洛从2.5mg,b id开始,每2周逐渐递增剂量,至最大剂量10mg,b id,或最大耐受剂量。两组疗程均为6个月。结果两组治疗后心率、心胸比例、LVEF、心功能分级较治疗前均有显著性差异(P<0.05),两组间比较也有显著性差异(P<0.05)。应用卡维地洛治疗充血性心力衰竭时,高剂量比低剂量明显改善心功能和提高LVEF。     

抗心衰丸治疗充血性心力衰竭疗效观察

目的：观察中药抗心衰丸治疗充血性心力衰竭（心衰）原疗效。方法：７８例充血性主衰患者随机分为２组，右强心，利尿，扩血管药治疗的基础上，治疗组（４８例）加用自拟纯中药抗心衰丸治疗，每次９ｇ口服，每日３次，对照组（３０例）口服巯甲丙脯酸２５ｍｇ，每日３次，对照组（３０例）口服巯甲丙脯酸２５ｍｇ，每日３次，２组均治疗２周（１个疗程）后观察比较疗效。结果：治疗组总有效率（９３．７５％）与对照组（７３．３３％     

倍他乐克治疗慢性充血性心力衰竭疗效观察

我院2000年1月-2004年5月收治慢性充血性心力衰竭病人90例。在子常规抗心力衰竭药物治疗的基础上联合应用倍他乐克观察治疗慢性充血性心力衰竭的临床疗效。     

Cardiac resynchronization therapy and obstructive sleep-related breathing disorder in patients with congestive heart failure

Objectives: To assess the impact of cardiac resynchronization therapy (CRT) with or without atrial overdrive pacing, on sleep‐related breathing disorder (SRBD). Introduction: CRT may have a positive influence on SRBD in patients who qualify for the therapy. Data are inconclusive in patients with obstructive SRBD. Methods: Consenting patients eligible for CRT underwent a baseline polysomnography (PSG) 2 weeks after implantation during which pacing was withheld. Patients with an apnea hypopnea index (AHI) ≥15 but <50 were enrolled and randomized to atrial overdrive pacing (DDD) versus atrial synchronous pacing (VDD) with biventricular pacing in both arms. Patients underwent two further PSGs 12 weeks apart. Results: Nineteen men with New York Heart Association class III congestive heart failure participated in the study (age 67.2 ± 7.5, Caucasian 78.9%, ischemic 73.7%). The score on Epworth Sleepiness Score was 7.3 ± 4.0, Pittsburgh Sleep Quality Index 7.4 ± 3.1, and Minnesota Living with Heart Failure Questionnaire 36.9 ± 21.9. There were no differences between the groups. At baseline, patients exhibited poor sleep efficiency (65.3 ± 16.6%) with nadir oxygen saturation of 83.5 ± 5.3% and moderate to severe SRBD (AHI 21.5 ± 15.3) that was mainly obstructive (central apnea index 3.3 ± 6.7/hour). On both follow‐up assessments, there was no improvement in indices of SRBD (sleep efficiency [68.3 ± 17.9%], nadir oxygen saturation of 82.8 ± 4.6%, and AHI 24.9 ± 21.9). Conclusion: In a cohort of elderly male CHF patients receiving CRT, CRT had no impact on obstructive SRBD burden with or without atrial overdrive pacing. (PACE 2011; 34:593–603)     

正性肌力药物治疗充血性心力衰竭

对正性肌力药物治疗充血性心力衰竭进行综述,其中包括洋地黄类和非强心甙类正性肌力药物,着重分析新近开发的药物,如多巴胺类、磷酸二酯酶抑制剂及钙增敏剂。     

心脏再同步化治疗充血性心力衰竭并发症的观察及护理

目的观察心脏再同步化治疗（CRT）充血性心力衰竭（CHF）患者并发症的疗效及护理。方法对12例CHF患者进行CRT,观察手术期并发症,并给予一定护理措施。结果12例患者中, 10例无并发症发生,2例并发冠状窦静脉夹层瘤。结论正确指导配合科学护理可有效减少CHF患者手术期并发症,是CRT植入手术成功的重要保障。     

运动疗法对老年慢性充血性心力衰竭患者的治疗效果

目的　观察运动疗法对老年慢性充血性心力衰竭患者的治疗效果。方法慢性心衰患者106例,分为运动治疗组(54例)和对照组(52例),综合观察患者运动前后的有关指标,并评价运动能力和生存质量。结果　动疗法可促进临床表现的好转,增强患者的运动能力,明显提高患者的生存质量;检测血浆心钠素、内皮素可作为运动观察的可靠指标。结论　动疗法对老年慢性充血性心力衰竭患者安全有效。     

Clinical factors associated with hyperkalemia in patients with congestive heart failure

BACKGROUND: Patients with congestive heart failure (CHF) are at risk for hyperkalemia because of coexisting comorbidities and use of multiple medications that impair potassium (K) excretion such as angiotensin converting enzyme (ACE) inhibitors. OBJECTIVE: To identify clinical factors associated with hyperkalemia on initial presentation in patients hospitalized for CHF. DESIGN: A case-control study. SETTING: Two university-affiliated tertiary-care hospitals. SUBJECTS: Using ICD-9 code for CHF, CHF admissions with hyperkalemia on presentation (cases) were identified from a population of 938 non-dialysis-dependent CHF patients. CHF admissions with normokalemia on presentation were used as controls. Hyperkalemia was defined as serum K > or = 5.6 mmol/L, and normokalemia as serum K > or = 3.5 and < or =5.5. METHODS: Data were collected on demographic characteristics, clinical variables, comorbidity and medication use. Factors associated with hyperkalemia on initial presentation were examined. RESULTS: Mean age did not differ between cases [76 years, standard deviation (SD) = 12] and controls (75 years, SD = 12) (P = 0.824). Mean potassium levels for cases and controls were 6.2 mmol/L (range 5.6 to 8.2) and 4.3 mmol/L respectively (P < 0.001). On multivariate analysis, diabetes mellitus [odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.04-5.59], creatinine clearance <40 mL/min (OR = 8.36, CI = 2.73-25.56), use of spironolactone (OR = 4.18, CI = 1.27-13.79), and use of ACE inhibitors (OR = 2.55, CI = 1.06-6.13) were independently associated with hyperkalemia. CONCLUSIONS: In CHF patients, hyperkalemia on presentation is independently associated with diabetes, creatinine clearance <40 mL/min, use of spironolactone, and use of ACE inhibitors. Recommendations for use of spironolactone and ACE inhibitors in CHF, and the intensity of serum K monitoring need to be clarified to account for patients at higher risk for hyperkalemia.     

运动康复对老年慢性充血性心衰的疗效

为观察运动康复疗法对老年慢性充血性心力衰竭患者的治疗效果，选择住院的慢性心衰竭患者２３例，分为运动治疗组（１３例）和对照组（１０例），运动治疗组进行运动康复治疗７～８周；对照组则不进行运动治疗，综合观察患者运动前后的有关指标，并评价运动能力和生活质量。认为运动康复疗法是安全有效的，可促进临床表现的好转，在心功能改变不明显的情况下，可增强患者的运动能力，明显提高患者的生活质量；检测血浆心钠素、内皮素可作为判断运动疗效的可靠指标。     

Integration of automatic intrathoracic fluid content measurement into clinical decision making in patients with congestive heart failure

Background: Hospitalizations due to decompensation are a frequent problem in treating patients with congestive heart failure (CHF). Continuous impedance measurement via implantable devices may detect pulmonary fluid accumulation due to worsening CHF. An acoustic alert might allow an earlier treatment of impending decompensation. An algorithm that implemented impedance measurement into clinical decision making in treating CHF patients was evaluated.
Methods: Forty-two CHF patients (ejection fraction: 27 ± 6%; New York Heart Association 2.9 ± 0.6) with cardiac resynchronization therapy and automatic impedance measurements were included. Upon an alert, a stepped therapy was initiated: category (1) overt decompensation, hospitalization; category (2) worsened CHF, increase of diuretics; category (3) no CHF worsening, brain natriuretic peptide (BNP) measurement, elevated BNP: increase of diuretics, normal BNP: no specific treatment.
Results: During 18 ± 4 months, 45 alerts were treated according to the algorithm. Eleven category 1 alerts led to hospitalization; 21 category 2 and 11 category 3 patients (elevated BNP) were treated conservatively. Two category 3 alerts (normal BNP) received no treatment.
Conclusions: Automatic impedance measurement can be integrated into CHF management. BNP measurement restricted to patients with alert but without clinical signs of worsened CHF may prevent premature therapy escalation.     

慢性充血性心力衰竭患者血清基质金属蛋白酶与骨桥蛋白变化的相关性研究

目的探讨慢性充血性心力衰竭（CHF）患者血清基质金属蛋白酶（MMPs）及其组织抑制因子（TIMPs）和骨桥蛋白（OPN）的变化及相关性。方法CHF患儿24例，正常对照组15例。采用ELISA法测定血清MMP-9和TIMP-1的含量,ELISA法测定血清OPN的含量，分析MMP-9／TIMP-1值与OPN和左室舒末内径（LVEDD）及射血分数（EF）的关系。结果CHF患者血清MMP-9、MMP-9／TIMP-1值和OPN含量明显增加（P均〈0．01），TIMP-1含量明显减少（P〈0．01），MMP-9／TIMP-1值与OPN含量和LVEDD呈正相关（P〈0．05），与EF呈负相关（P〈0．05）。结论CHF患者MMP-9／TIMP-1值与OPN含量呈明显的正相关；MMP-9／TIMP-1值与OPN含量的变化，可反映心衰的严重程度并加速了心功能的恶化。     

大剂量螺内酯与糖皮质激素联合治疗重症慢性心力衰竭的临床观察

目的探讨顽固性慢性充血性心力衰竭(CHF)时,在常规治疗的基础上加用大剂量螺内酯与泼尼松,观察对水、Na 、K 代谢及心功能的影响。方法54例严重CHF患者(心功能Ⅲ~Ⅳ级,D期),随机分为对照组(27例)与研究组(27例),对照组采用常规治疗(包括螺内酯20 mg/d),研究组在常规治疗基础上,螺内酯60 mg/d,泼尼松40 mg/d连续应用30天。分析治疗后两组患者的一般临床情况、左室射血分数(EF)、血清Na 、K 、肌酐及24小时尿量、尿Na 、尿K 的变化。结果两组患者在治疗后尿量及EF显著增加,但研究组患者用药后尿量较对照组增加更明显,研究组长血清Na 7天及30天均高于对照组,7天Na (138.03±3.97)mmol vs(134.48±5.18)mmol/L,30天Na (137.17±3.57)mmol/L vs(134.00±4.46)mmol/L(均P<0.05);血清K 7天及30天亦均高于对照组,7天K (4.07±0.42)mmol/L vs(3.73±0.33)mmol/L,30天K (4.18±0.49)mmol/L vs(3.79±0.44)mmol/L(均P<0.05);而治疗后研究组血清肌酐7天及30天低于对照组,差异有统计学意义,7天K (92.93±28.65)mmol/L vs(123.19±30.79)mmol/L,30天K (90.07±30.32)mmol/Lvs(115.00±40.61)mmol/L(均P<0.05),尿Na 高于对照组(P<0.05)。结论常规治疗的基础上,适量应用糖皮质激素及大剂量螺内酯可使重症CHF患者在保持K 、Na 平衡及有效血容量的基础上能更明显地减轻过重的水负荷,改善心功能。     

不同左心室射血分数老年充血性心力衰竭患者药物治疗的临床研究

目的 探讨充血性心力衰竭（心衰）患者的临床特征和药物治疗情况以及不同左心室射血分数（LVEF）心衰患者的并发症与药物治疗情况.方法 连续调查2001年1月-2002年1月香港大学玛丽医院收住60岁以上的老年充血性心衰患者,符合ICD-9 CM诊断标准,并用弗明翰研究标准确诊,共计1 074例次,收集入院时及入院3 d内的超声心动图、心电图、X线胸片等检查结果以及患者出院时转归、出院带药情况.结果 ①女性充血性心衰患者几乎为男性患者的2倍,年龄≥65岁者占95.5%,≥80岁者占50.6%,按美国纽约心脏协会（NYHA）心功能分级,Ⅲ和Ⅳ级占70.2%, 521例（占48.5%）入院治疗1次.②充血性心衰的主要并发症为糖尿病和高血压.③399例次行超声心动图检查者中,208例次（占52.1%）LVEF〈0.50,191例次（占47.9%）LVEF≥0.50的患者更倾向于女性,年龄≥80岁,而冠心病及糖尿病较少发生,心房颤动84例次（占44.0%）占多数（P〈0.05）.糖尿病、完全性左束支传导阻滞及心肌梗死病史常伴随LVEF〈0.50的患者（P〈0.05）.④大部分患者均接受利尿剂治疗,LVEF〈0.50的患者中使用血管紧张素转换酶抑制剂（ACEI）131例次（占63.0%）,地高辛47例次（占22.6%）,β-受体阻滞剂25例次（占12.0%）,钙阻滞剂29例次（占13.9%）,而LVEF≥0.50的患者分别有119例次（62.3%）、67例次（35.1%）、18例次（占9.4%）和35例次（占18.3%）使用上述药物,地高辛多用在LVEF≥0.50的患者（P〈0.05）.结论 ①LVEF〈0.50与≥0.50的充血性心衰患者单从临床症状和体征上较难区别,目前强调对每个心衰患者尽可能进行早期超声心动图检查,这是区别两类心衰的重要手段.②ACEI、β-受体阻滞剂的使用与治疗指南还有一定距离.③尽早地区分LVEF〈0.50与≥0.50充血性心衰患者将有利于抗心衰治疗.