心衰的4个周期，警觉自己处在哪个周期？
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><a style="color: black;">心力衰竭</a></span>是<span style="color: black;">各样</span>心血管<span style="color: black;">疾患</span>的终末<span style="color: black;">周期</span>，<span style="color: black;">亦</span>是<span style="color: black;">重点</span>的死亡<span style="color: black;">原由</span>。<span style="color: black;">针对</span>心内科的<span style="color: black;">大夫</span><span style="color: black;">来讲</span>，<span style="color: black;"><a style="color: black;">心衰</a></span>的治疗<span style="color: black;">亦</span>是最具挑战性的。最新的调查结果<span style="color: black;">表示</span>，我国<span style="color: black;"><a style="color: black;">慢性心衰</a></span>的<span style="color: black;">病人</span><span style="color: black;">已然</span><span style="color: black;">提升</span>到1370万人。心衰<span style="color: black;">按照</span>病情的<span style="color: black;">发展</span>，<span style="color: black;">能够</span>分为4个<span style="color: black;">周期</span>。<span style="color: black;"><a style="color: black;">陈<span style="color: black;">医生</span></a></span>今天介绍一下这4个<span style="color: black;">周期</span>，有心血管<span style="color: black;">疾患</span>的<span style="color: black;">能够</span>对照一下，<span style="color: black;">日前</span><span style="color: black;">处在</span>哪一个<span style="color: black;">周期</span>。</p>
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<h1 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">第1</span><span style="color: black;">周期</span>：前心衰<span style="color: black;">周期</span></h1>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span>属于心衰前<span style="color: black;">周期</span>，<span style="color: black;">亦</span><span style="color: black;">便是</span>还<span style="color: black;">无</span><span style="color: black;">出现</span>心衰，心脏<span style="color: black;">亦</span><span style="color: black;">无</span><span style="color: black;">显现</span>器质性的改变，只是存在心衰的高危<span style="color: black;">原因</span>，<span style="color: black;">将来</span>得心衰的概率大大<span style="color: black;">增多</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其实<span style="color: black;">非常多</span>人都<span style="color: black;">处在</span>这个<span style="color: black;">周期</span>，可能<span style="color: black;">她们</span>自己都不清楚。<span style="color: black;">例如</span><span style="color: black;"><a style="color: black;">冠心病</a></span>、高血压都是<span style="color: black;">引起</span>心衰第1位和第2位<span style="color: black;">原由</span>。<span style="color: black;">因此呢</span>，冠心病病人，高血压病人都<span style="color: black;">处在</span><span style="color: black;"><a style="color: black;">前心衰</a></span><span style="color: black;">周期</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，糖尿病病人、<span style="color: black;">肥壮</span>、<span style="color: black;"><a style="color: black;">代谢</a><span style="color: black;">综合症</span></span>、风湿性心肌脏、甲亢、<span style="color: black;"><a style="color: black;">严重贫血</a></span>、<span style="color: black;">长时间</span>酗酒的人这些都<span style="color: black;">处在</span>前心衰<span style="color: black;">周期</span>。总之，一切可能影响到心脏的<span style="color: black;">疾患</span>，都属于这个<span style="color: black;">周期</span>。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span>该怎么办?</p>当然，<span style="color: black;">处在</span>这个<span style="color: black;">周期</span><span style="color: black;">亦</span><span style="color: black;">不消</span>太担心，只要好好地治疗高血压、冠心病、糖尿病这些<span style="color: black;">疾患</span>，有可能<span style="color: black;">始终</span><span style="color: black;">处在</span>这个<span style="color: black;">周期</span>。当然说起来很简单，<span style="color: black;">掌控</span>好血压、糖尿病。<span style="color: black;">然则</span>有时候<span style="color: black;">亦</span><span style="color: black;">不易</span>做到。<span style="color: black;">倘若</span><span style="color: black;">长时间</span><span style="color: black;">掌控</span><span style="color: black;">欠好</span>，<span style="color: black;">那样</span>可能就进入第二<span style="color: black;">周期</span>了。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-66075ef93636b827c6de6da7ba74d176_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<h1 style="color: black; text-align: left; margin-bottom: 10px;">第二<span style="color: black;">周期</span>：<span style="color: black;"><a style="color: black;">前临床心衰</a></span><span style="color: black;">周期</span></h1>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">前临床心衰，指的是还<span style="color: black;">无</span><span style="color: black;">显现</span>心衰的症状，<span style="color: black;">然则</span>在心衰的道路上又前进了一步。心脏<span style="color: black;">已然</span><span style="color: black;">显现</span>了<span style="color: black;"><a style="color: black;">器质性</a></span>的改变。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>高血压病人，做心脏超声提示<span style="color: black;"><a style="color: black;">左心室肥厚</a></span>，这<span style="color: black;">便是</span><span style="color: black;">长时间</span>高血压<span style="color: black;">引起</span>的<span style="color: black;"><a style="color: black;">心脏器质性改变</a></span>。<span style="color: black;">另一</span>，还<span style="color: black;">例如</span>之前得过<span style="color: black;"><a style="color: black;">急性心肌梗死</a></span>的人，心肌有一部分<span style="color: black;">已然</span>永久的坏死，<span style="color: black;">亦</span>属于出个<span style="color: black;">周期</span>。还有<span style="color: black;"><a style="color: black;">心脏瓣膜</a></span><span style="color: black;">显现</span>问题，<span style="color: black;">例如</span><span style="color: black;"><a style="color: black;">二尖瓣狭窄</a></span>、主动脉关闭不全等。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左边正常的心脏，右边心脏<span style="color: black;">显著</span>的肥厚</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span>该怎么办？</p><span style="color: black;">处在</span>这个<span style="color: black;">周期</span>的病人要<span style="color: black;">小心</span>了，<span style="color: black;">由于</span>心脏<span style="color: black;">已然</span><span style="color: black;">显现</span>器质性变化，想要逆转是<span style="color: black;">不易</span>的。一方面，还是要治疗原发病，<span style="color: black;">例如</span>高血压<span style="color: black;">引起</span>的左心室肥厚，<span style="color: black;">掌控</span>好血压是最<span style="color: black;">重要</span>的。<span style="color: black;">况且</span>血压最好<span style="color: black;">掌控</span>的理想一点。<span style="color: black;">此刻</span><span style="color: black;">咱们</span>血压<span style="color: black;">掌控</span>的基本<span style="color: black;">目的</span>是140/90mmHg。<span style="color: black;">然则</span>这个血压<span style="color: black;">目的</span>其实并不是很完美，最好能<span style="color: black;">掌控</span>到130/80mmHg以下。另一方面，<span style="color: black;">便是</span><span style="color: black;">运用</span><span style="color: black;">有些</span>能够逆转心室重构<span style="color: black;">药品</span>。<span style="color: black;">例如</span>降压药里面：ACEI类（血管紧张素转换酶<span style="color: black;">控制</span>剂，<span style="color: black;">例如</span>培哚普利、<span style="color: black;"><a style="color: black;">雷米普利</a></span>、依那普利等）；ARB类：（血管紧张素II受体拮抗剂，缬沙坦、<span style="color: black;"><a style="color: black;">替米沙坦</a></span>、奥美沙坦等）；β受体阻滞剂（<span style="color: black;"><a style="color: black;">倍他乐克</a></span>、比索洛尔）；ARNI类<span style="color: black;">药品</span>（<span style="color: black;">日前</span>国内有的<span style="color: black;">药品</span>是<span style="color: black;"><a style="color: black;">沙库巴曲缬沙坦</a></span>）这些<span style="color: black;">药品</span>都<span style="color: black;">拥有</span>逆转<span style="color: black;"><a style="color: black;">心室重构</a></span>的效果，至于能逆转多少，还是要看<span style="color: black;">详细</span>的病情。<span style="color: black;">例如</span>原来心室肥厚的，吃一段时间，心室肥厚厚度减少了。至于完全恢复，还是很难的。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pica.zhimg.com/80/v2-03a7c4c6a3467e0094578ceb1532c8b6_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<h1 style="color: black; text-align: left; margin-bottom: 10px;">第三<span style="color: black;">周期</span>：临床心衰阶段</h1>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span><span style="color: black;">便是</span><span style="color: black;">已然</span><span style="color: black;">显现</span><span style="color: black;"><a style="color: black;">心衰症状</a></span>了，以心衰来看病的人<span style="color: black;">重点</span><span style="color: black;">便是</span>这个<span style="color: black;">周期</span>。前面说过了，<span style="color: black;">处在</span>这个<span style="color: black;">周期</span>的病人我国大概有1370万，增长得<span style="color: black;">火速</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">原由</span>可能<span style="color: black;">亦</span>是多方面的，<span style="color: black;">例如</span>人口老龄化，随着年龄的增长，心衰的发病率<span style="color: black;">显著</span><span style="color: black;">增多</span>，70岁以上老年人，患病率在10%以上。其次，高血压、糖尿病、<span style="color: black;">肥壮</span>这些<span style="color: black;">疾患</span>患病人数的<span style="color: black;">增加</span>。最后，随着医学技术的发展，急性心肌梗死的院内死亡率的下降，<span style="color: black;">引起</span>一部分原来救不活的病人，<span style="color: black;">便是</span>治好了。这部分病人在不久的将来，可能<span style="color: black;">亦</span>会<span style="color: black;">作为</span>心衰病人。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">临床心衰<span style="color: black;">周期</span>有<span style="color: black;">那些</span>症状？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心衰经典的症状总结起来<span style="color: black;">重点</span>是3点：活动耐力的下降、<span style="color: black;">呼气</span>困难以及体液潴留（<span style="color: black;">例如</span><span style="color: black;"><a style="color: black;">双下肢水肿</a></span>、胃肠道淤血、肺水肿等）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、活动耐力的下降</p>心衰病人来就诊，总是会<span style="color: black;">这般</span>说，以前<span style="color: black;">能够</span>一口气爬上4楼，<span style="color: black;">近期</span>不<span style="color: black;">晓得</span>怎么了，爬上1楼就喘得不行，要<span style="color: black;">休憩</span>很久<span style="color: black;">才可</span>恢复。这<span style="color: black;">便是</span>活动耐力的下降，活动后恢复的时间延长。<span style="color: black;">为何</span>会<span style="color: black;">显现</span>这种<span style="color: black;">状况</span>，其实很好理解。心脏就<span style="color: black;">好似</span>是<span style="color: black;">咱们</span>人体的发动机。发动机不行了，人的活动能力肯定变差了。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://picx.zhimg.com/80/v2-c4ee575b41efa31064dcd13913dcdfc2_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、<span style="color: black;">呼气</span>困难</p>心衰病人<span style="color: black;">呼气</span>困难的类型<span style="color: black;">非常多</span>，从最轻的劳力性的<span style="color: black;">呼气</span>困难，<span style="color: black;">便是</span>活动后感觉气<span style="color: black;">不足</span>，<span style="color: black;">呼气</span>困难；再到<span style="color: black;"><a style="color: black;">夜间阵发性<span style="color: black;">呼气</span>困难</a></span>，<span style="color: black;">便是</span>夜里睡觉时<span style="color: black;">忽然</span>感觉胸闷难受被憋醒。最后是<span style="color: black;"><a style="color: black;">端坐<span style="color: black;">呼气</span></a></span>，<span style="color: black;">病人</span><span style="color: black;">没</span>法躺下睡觉，一躺下就喘得不行，最严重的<span style="color: black;">乃至</span>坐着都喘得不行。<span style="color: black;">这般</span>的病人不仅病人自己难受，<span style="color: black;">乃至</span><span style="color: black;">大夫</span>看着都难受，<span style="color: black;">然则</span>到了这个<span style="color: black;">周期</span>，有时候<span style="color: black;">药品</span><span style="color: black;">亦</span>不起<span style="color: black;">功效</span>了。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pica.zhimg.com/80/v2-d03bb9d525de38b5b5626724ad177a46_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、体液潴留</p>心脏里面的血液排不出去，自然心脏外的血液<span style="color: black;">亦</span>进不去心脏。<span style="color: black;">这般</span>一来，血液只能淤积在血管里，淤积得多了，血液里面的液体就会从血管跑出来。<span style="color: black;">由于</span>双腿是人最低的<span style="color: black;">地区</span>，<span style="color: black;">因为</span>重力的<span style="color: black;">功效</span>，自然是双下肢先肿起来。<span style="color: black;">另一</span>，胃肠道的血液淤积，<span style="color: black;">亦</span>会<span style="color: black;">引起</span>心衰病人<span style="color: black;">显现</span>没胃口，消化能力下降、肚子胀、便秘等症状。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="data:image/svg+xml;utf8," style="width: 50%; margin-bottom: 20px;">
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<div style="color: black; text-align: left; margin-bottom: 10px;">该<span style="color: black;">照片</span>有可能会<span style="color: black;">导致</span>不适</div>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span>该怎么办？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span><span style="color: black;">亦</span>是针对心衰好好的治疗。心衰的治疗<span style="color: black;">药品</span><span style="color: black;">重点</span>有两大类，一种是改善<span style="color: black;">病人</span>预后的，另一种是改善心衰症状的。两类<span style="color: black;">药品</span>都<span style="color: black;">必须</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、改善心衰预后的<span style="color: black;">药品</span></p>这类<span style="color: black;">药品</span>上面<span style="color: black;">已然</span><span style="color: black;">说到</span>过了，<span style="color: black;">重点</span>是改善心室重构的。<span style="color: black;">例如</span>ACEI、ARB类、β受体阻滞剂、醛固酮拮抗剂（螺内酯）以及ARNI类<span style="color: black;">药品</span>。<span style="color: black;">按照</span>相关<span style="color: black;">科研</span>，与安慰剂相比，<span style="color: black;">运用</span>ACEI类<span style="color: black;">药品</span><span style="color: black;">能够</span>使心衰相对死亡<span style="color: black;">危害</span>降低16%，ARB<span style="color: black;">能够</span>降低17%，β受体阻滞剂<span style="color: black;">能够</span>降低34%，醛固酮拮抗剂（螺内酯）<span style="color: black;">能够</span>降低30%。ACEI+ARB，β受体阻滞剂，醛固酮拮抗剂（螺内酯）这三类<span style="color: black;">药品</span>被<span style="color: black;">叫作</span>为心衰治疗的“金三角”。（ACEI和ARB<span style="color: black;">能够</span>看做同一类<span style="color: black;">药品</span>）ARNI类<span style="color: black;">药品</span>是近几年<span style="color: black;">显现</span>的治疗心衰的<span style="color: black;">药品</span>，<span style="color: black;">科研</span><span style="color: black;">显示</span>，<span style="color: black;">能够</span>在依那普利（ACEI类<span style="color: black;">药品</span>的一种）的<span style="color: black;">基本</span>上，再次降低心衰死亡率20%<span style="color: black;">上下</span>。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-f12937cb6063bb7185a899026eec4a7a_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、改善症状的<span style="color: black;">药品</span></p>这类<span style="color: black;">药品</span><span style="color: black;">重点</span>是<span style="color: black;"><a style="color: black;">利尿剂</a></span>，<span style="color: black;">能够</span>减轻<span style="color: black;">身体</span>的液体潴留。<span style="color: black;">例如</span>双下肢水肿了，吃一段时间利尿剂，<span style="color: black;">能够</span>把水排出去，腿<span style="color: black;">亦</span>就不肿了。气喘的症状<span style="color: black;">亦</span><span style="color: black;">能够</span>得到缓解。其次是强心<span style="color: black;">药品</span>，<span style="color: black;">重点</span>的<span style="color: black;">药品</span>是<span style="color: black;"><a style="color: black;">地高辛</a></span>，<span style="color: black;">能够</span><span style="color: black;">加强</span>心肌的收缩力。<span style="color: black;">此刻</span>用得越来越少了，只要<span style="color: black;">运用</span>了利尿剂之后，<span style="color: black;">病人</span>还是不缓解，<span style="color: black;">能够</span>加用。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://picx.zhimg.com/80/v2-298f6590ff353e43bcb349f64949148a_720w.webp?source=1def8aca" style="width: 50%; margin-bottom: 20px;"></div>
<h1 style="color: black; text-align: left; margin-bottom: 10px;">第四<span style="color: black;">周期</span>：难治性终末期心衰<span style="color: black;">周期</span></h1>这个<span style="color: black;">周期</span>的病人属于心衰的终末期，虽然经过严格的<span style="color: black;">药品</span>治疗，<span style="color: black;">然则</span><span style="color: black;">休憩</span>的时候还是会<span style="color: black;">显现</span>症状。<span style="color: black;">因此呢</span>，<span style="color: black;">必须</span>经常性的住院治疗。不仅病人自己痛苦，<span style="color: black;">况且</span>家人<span style="color: black;">亦</span>跟着受累。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">周期</span>该怎么治疗？</p><span style="color: black;"><a style="color: black;">心脏移植</a></span>是<span style="color: black;">最后</span>的治疗<span style="color: black;">办法</span>，<span style="color: black;">然则</span>心脏的供体以及术后的<span style="color: black;"><a style="color: black;">排异反应</a></span>是一个问题。<span style="color: black;">日前</span>心脏移植在<span style="color: black;">有些</span>大医院<span style="color: black;">亦</span>是有开展的。<span style="color: black;"><a style="color: black;">人工心脏</a></span><span style="color: black;">移植</span><span style="color: black;">亦</span>是近期开展的高端手术，预后<span style="color: black;">亦</span>是非常好的 <span style="color: black;"><a style="color: black;">心脏再同步化治疗</a></span>，有些心衰病人存在房室、室间室内收缩不同步的问题，<span style="color: black;">能够</span><span style="color: black;">移植</span>仪器，<span style="color: black;">帮忙</span>心脏同步收缩。<span style="color: black;">能够</span>改善心衰症状、<span style="color: black;">加强</span>生活质量，减少住院率和死亡率。当然并不是所有的病人都有效。<h1 style="color: black; text-align: left; margin-bottom: 10px;">总结：</h1>心衰<span style="color: black;">能够</span>说是心血管内科<span style="color: black;">大夫</span>的终极考验，<span style="color: black;">欠好</span>治。<span style="color: black;">尤其</span>是确诊心衰之后，<span style="color: black;">亦</span><span style="color: black;">便是</span>达到第三<span style="color: black;">周期</span>之后，50%的病人在5年内死亡。<span style="color: black;">因此</span>，<span style="color: black;">日前</span><span style="color: black;">处在</span>第<span style="color: black;">1、</span>第二<span style="color: black;">周期</span>的<span style="color: black;">病人</span><span style="color: black;">必定</span>要好好治疗，积极预防。推迟<span style="color: black;">或</span>不进入第三<span style="color: black;">周期</span>。
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我完全赞同你的观点，思考很有深度。 楼主的文章非常有意义，提升了我的知识水平。
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