美国心力衰竭实用指南解读急性失代偿性心力衰竭的评估和处理

美国心力衰竭学会在2006年第1期心力衰竭杂志上发布了心力衰竭实用指南(Comprehensive Heart Failure Practice Guideline),其中包括心室重塑、心功能不全和心力衰竭的预防,心功能不全和心力衰竭患者的评估,无症状左室射血分数减低患者的处理和急性失代偿性心力衰竭的评估和处理等.本文就急性失代偿性心力衰竭的评估和处理的有关内容作一介绍,以供参考.     

急性心力衰竭诊断和治疗指南（2010）

@@@@文章介绍急性心力衰竭诊断和治疗指南。     

急性心力衰竭诊断和治疗指南(2010)

文章介绍急性心力衰竭诊断和治疗指南.     

中国心力衰竭诊断和治疗指南2014

文章介绍中国心力衰竭诊断和治疗指南2014年版。     

慢性心力衰竭急性失代偿合并低钠血症治疗体会

目的探讨慢性心力衰竭(chronic heart failure,CHF)急性失代偿合并低钠血症的临床治疗方法。方法选择2010年1月—2015年1月收治的31例CHF急性失代偿合并低钠血症患者作为观察组,另选同期31例CHF急性失代偿但不合并低钠血症患者作为对照组,观察并比较两组患者病死率、住院时间及左室射血分数(left ventricular ejection fraction,LVEF)。将观察组患者随机分为A组15例和B组16例,A组给予常规抗心力衰竭(心衰)治疗,B组在A组的基础上给予纠正低钠血症治疗。比较两组治疗后血钠水平及临床疗效。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果观察组病死率、住院时间、LVEF分别为32.3%、(15.8±2.6)d、(37.1±0.1)%,对照组分别为9.7%、(10.5±3.0)d、(44.5±0.1)%,两组比较差异均有统计学意义(均P0.05)。B组治疗后血钠水平、总有效率分别为(136.5±3.2)mmol/L、81.3%,均明显高于A组的(130.0±2.8)mmol/L、40.0%,差异均有统计学意义(均P0.05)。结论对于CHF急性失代偿合并低钠血症患者,应在抗心衰治疗基础上,积极纠正低钠血症,从而明显改善患者的心功能及预后。     

急性失代偿性心力衰竭治疗中的临床用药指导教学体会

目的以左西孟旦用于急性失代偿性心力衰竭(ADHF)的治疗,探讨临床用药指导实习教学的体会。方法以2018年1-12月在该院实习的学生24名作为研究对象,随机分成对照组和观察组,每组12名。对照组选用传统带教方式完成临床教学,观察组采用以左西孟旦治疗ADHF的临床用药指导教学模式,比较两组患者的临床治疗效果、两组实习生的考试成绩及对不同教学模式的满意度。结果观察组学生出科考试成绩明显高于对照组,观察组学生对新教学方式满意度更高,观察组患者心衰症状缓解情况、心功能提高程度明显高于对照组,差异有统计学意义(P<0.05)。结论左西孟旦治疗ADHF的教学中,以临床用药指导教学,既可提高实习生对ADHF相关疾病知识、治疗方法、常用药物及禁忌的掌握程度,还可增强学生交流、沟通的能力,启发探索理论学习与临床实践融合的能力,使学生在新型教学方式下获益更多,教学效果理想。     

重组人脑利钠肽辅助治疗急性失代偿性心力衰竭

目的 探讨重组人脑利钠肽（rhBNP）辅助治疗急性失代偿性心力衰竭（ADHF）的效果。方法 将2019年1月至2021年1月于我院就诊的103例ADHF患者按照随机数表法分为对照组（n=52）和观察组（n=51）。对照组采用单硝酸异山梨酯（ISMN）治疗,观察组采用rhBNP治疗。评估两组疗效、总液体出入量、利尿剂用量、心功能、心肌酶水平、不良反应。结果 观察组总有效率94.12%(48/51)高于对照组80.77%(42/52)(P <0.05);两组总液体输入量、总液体输出量、液体出入量差值比较,差异无统计学意义（P>0.05）;观察组利尿剂用量低于对照组（P <0.05）;与治疗前相比,治疗后两组LVEF、SV升高,且观察组高于对照组（P <0.05）;治疗后两组LVEDD水平降低,且观察组低于对照组（P <0.05）;观察组的CK、LDH、cTnT均低于对照组（P <0.05）。两组不良反应率比较无统计学意义（P>0.05）。结论 rhBNP辅助治疗ADHF疗效显著,可减少利尿药物的使用剂量,并降低心肌损伤,改善心功能,且安全性与ISM...     

失代偿性心力衰竭患者入院血钾与预后的关系

[目的]回顾性观察患者入院时血清钾水平与严重失代偿心力衰竭预后各指标的相关性。[方法]纳入2003年1月~2004年12月所有收治本院的、入院诊断为心力衰竭,心功能NYHA分级III~IV级的患者共289例,记录入院时血清钾水平,观察血清钾水平与预后的相关性。[结果]血清钾水平与静脉注射硝酸甘油用量呈正相关(P=0.043),血清钾水平增高增加病死率(P﹤0.0001)。[结论]入院时血清钾水平在4.2mmol/L左右严重失代偿性心力衰竭患者的预后较好,对于心力衰竭患者监测血清钾是非常必要的。     

急性心力衰竭诊治进展

急性心力衰竭作为一种常见的临床重症，其患者常发病急、重，预后差、死亡率高，近年来日益受到人们的关注。随着医学的发展，急性心力衰竭诊断措施与治疗方案日渐成熟，本文将就其目前诊治进展作一综述。     

Acute heart failure: a practical guide to management

Acute heart failure is a common cause of referral and admission to hospital. It requires prompt recognition and treatment. This article will address the practical issues regarding diagnosis, investigation, treatment and prevention of recurrence.     

Physician opinions on the implementation of the SIGN guideline for heart failure

BACKGROUND AND AIMS: To assess physician opinion of and attitudes to, the Scottish Intercollegiate Guideline Network (SIGN) guideline for chronic heart failure (CHF) due to left ventricular systolic dysfunction. METHODS AND RESULTS: A questionnaire examining physicians' attitudes and their use of the SIGN guideline for CHF was distributed to 158 physicians in two teaching hospitals within one NHS trust. 65% of recipients responded. More cardiologists had read the guideline compared to non-cardiologists (91 vs 56%, p < 0.05). The majority of cardiologists and non-cardiologists agreed that it was applicable to their patients (92 vs 79%, p > 0.1) and that implementation may reduce hospital admissions (65 vs 59%, p > 0.5). In general, compliance was thought to be a problem in only a minority of patients in both groups for angiotensin converting enzyme inhibitors (8 vs 19%), diuretics (12 vs 29%) and digoxin (17 vs 19%, all p > 0.1). Beta-blocker compliance was identified as a problem by both groups (50 vs 53%, P > 0.5) while fewer cardiologists reported compliance as a problem with spironolactone (4 vs 25%, p < 0.05). More cardiologists felt that there was a need for a community based CHF nurse specialist (100 vs 57%, p < 0.001), and that this strategy would reduce hospital admissions (92 vs 57%, p < 0.01). CONCLUSIONS: Differences exist between cardiologist and non-cardiologist physicians' awareness of the SIGN guideline for CHE. Furthermore, we have shown differences in reported implementation of the guideline and perceived difficulties with specific drug therapies. This is in spite of high levels of agreement in both groups with the treatment suggested by the guideline and the anticipated benefits resulting from its implementation.