【做客直播间·FM912·健康合伙人】心力衰竭知多少——内科负责人李万能
<img src="https://mmbiz.qpic.cn/mmbiz_gif/Ljib4So7yuWhaTeG2u7bEwF1HJNXbF7yj3Kwvv5Hmf5422j2twUIGnTnbgic2WaEKJl1vYVRfCFibY5Ueh3bj1Mgg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_png/C1PyZNmGHiaK75Ev8EbSiaXzyLAXZBbITjT86NtfnSzzzboGfgX045NiamlRlhg73xSmpenRNtopibQXgNEn7YnwKA/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/bL2iaicTYdZn4SdrQOo1m5ehdyL2Btpyx9Ticwl4OhEEAH0QnbjL5GlhpmW7ty6DiaRu8acG23ic42WXV9WSDX2c7hw/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/bL2iaicTYdZn4SdrQOo1m5ehdyL2Btpyx9cPqKXljvF86M0mLKwTto3d0jibNNDfbic2bqibOKZmT6wcdibwtib2S4edQ/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">4月9日，FM91.2《健康合伙人》栏目开播，毕节市七星关区人民医院（贵州医科大学<span style="color: black;">附庸</span>医院七星关分院）内科负责人李万能做客直播间，与<span style="color: black;">大众</span><span style="color: black;">一块</span>聊一聊心力衰竭。</span><img src="https://mmbiz.qpic.cn/mmbiz_png/bL2iaicTYdZn4SdrQOo1m5ehdyL2Btpyx9cPqKXljvF86M0mLKwTto3d0jibNNDfbic2bqibOKZmT6wcdibwtib2S4edQ/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/C1PyZNmGHiaKbguh1UURq2ibPF8YRaKTibxiaaaOskkwp8YjenRGib3icFU3IxQBZ0oicIkV1S5evDWIedofJIGVhjMww/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰是<span style="color: black;">各样</span>心脏<span style="color: black;">疾患</span>的严重表现或晚期<span style="color: black;">周期</span>、死亡率和再住院率居高不下，发病率为1-2%。随着我国人口老年化加剧，冠心病、糖尿病、高血压、<span style="color: black;">肥壮</span>等慢性病的发病呈<span style="color: black;">提升</span>趋势，这些<span style="color: black;">原因</span><span style="color: black;">引起</span>我国心衰患病率呈<span style="color: black;">升高</span>趋势，心衰发病年龄不等，以老年人<span style="color: black;">占多数</span>，且临床表现不同，且病患文化水平差异，<span style="color: black;">引起</span>心衰诊断、治疗<span style="color: black;">显现</span>了滞后。<span style="color: black;">针对</span>今天的这个<span style="color: black;">专题</span>，<span style="color: black;">非常多</span><span style="color: black;">伴侣</span><span style="color: black;">认识</span>得比较少，<span style="color: black;">亦</span>缺乏<span style="color: black;">必定</span>的<span style="color: black;">注意</span>，下面<span style="color: black;">咱们</span>针对心力衰竭来做一个<span style="color: black;">仔细</span>的介绍。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/Ljib4So7yuWjVsaTygX5CCGxuYZaPeibrpfOOGAjXfTkTp3AIPeXv08iayGTH94Xcmvk4RJxs9NNSc2vzCoCiaXOSQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：什么叫心力衰竭（简<span style="color: black;">叫作</span>心衰）？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭是<span style="color: black;">各样</span>心脏结构或功能性<span style="color: black;">疾患</span><span style="color: black;">引起</span>心室充盈和（或）射血功能受损，心排血量<span style="color: black;">不可</span>满足机体组织代谢<span style="color: black;">必须</span>，以肺循环和（或）体循环淤血，器官、组织血液灌注不足为临床表现的一组<span style="color: black;">综合症</span>。<span style="color: black;">重点</span>表现为<span style="color: black;">呼气</span>困难、体力活动受限和体液潴留。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰临床分型？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（1）</span><span style="color: black;">按心力衰竭发展的速度可分为急性和慢性二种，以慢性<span style="color: black;">占多数</span>。急性者以左心衰竭较<span style="color: black;">平常</span>，<span style="color: black;">重点</span>表现为急性肺水肿</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（2）<span style="color: black;">按照</span>心力衰竭<span style="color: black;">出现</span>的部位可分为左心、右心和全心衰竭。左</span><span style="color: black;">心衰竭的特征是肺循环淤血；右心衰竭以体循环淤血为<span style="color: black;">重点</span>表现。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（3）</span><span style="color: black;">收缩性或</span><span style="color: black;">舒张性心力衰竭。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（4）按症状的有<span style="color: black;">没</span>可分为<span style="color: black;">没</span>症状性心力衰竭和充血性心力衰竭。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰<span style="color: black;">平常</span>病因有<span style="color: black;">那些</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭的病因<span style="color: black;">包含</span>：原发性心肌损害，心脏负荷过重，<span style="color: black;">包含</span>压</span><span style="color: black;">力负荷过重和/或容量负荷过重。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：诱发心衰<span style="color: black;">爆发</span>的<span style="color: black;">原由</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭的诱因<span style="color: black;">包含</span>：感染，<span style="color: black;">心率</span>失常，血容量<span style="color: black;">增多</span>，过度体力劳动和<span style="color: black;">心情</span>激动，治疗<span style="color: black;">欠妥</span>，妊娠，有心脏病加重或并发其他<span style="color: black;">疾患</span>等，其中感染、<span style="color: black;">心率</span>失常、血容量<span style="color: black;">增多</span>是最<span style="color: black;">重点</span>的诱因。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰有<span style="color: black;">那些</span><span style="color: black;">平常</span>症状和表现？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.不同程度的<span style="color: black;">呼气</span>困难：劳力性<span style="color: black;">呼气</span>困难是左心衰竭最早<span style="color: black;">显现</span>的症状，因运动使回心血量<span style="color: black;">增多</span>，左心房压力<span style="color: black;">上升</span>，加重肺淤血，<span style="color: black;">导致</span><span style="color: black;">呼气</span>困难的运动量随心衰程度加重而减少；端坐<span style="color: black;">呼气</span>是肺淤血达到<span style="color: black;">必定</span>程度时<span style="color: black;">病人</span><span style="color: black;">不可</span>平卧，因平卧时回心血量<span style="color: black;">增加</span>且横膈上抬，<span style="color: black;">呼气</span>更为困难，高枕卧位、半卧位<span style="color: black;">乃至</span>端坐时方可好转；夜间阵发性<span style="color: black;">呼气</span>困难是<span style="color: black;">病人</span>睡后<span style="color: black;">忽然</span>因憋气而惊醒，被迫取坐位，重者可有哮鸣音，<span style="color: black;">叫作</span>为“心源性哮喘”，多于端坐<span style="color: black;">休憩</span>后缓解。其<span style="color: black;">出现</span>机制除<span style="color: black;">睡觉</span>平卧血液重新分配使肺血量<span style="color: black;">增多</span>外，夜间迷走神经张力<span style="color: black;">增多</span>、小支气管收缩、横膈抬高、肺活量减少等<span style="color: black;">亦</span>是促发<span style="color: black;">原因</span>；急性肺水肿是“心源性哮喘”的进一步发展，是左心衰<span style="color: black;">呼气</span>困难最严重的形式。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.咳嗽、咳痰、咯血：咳嗽、咳痰是肺泡和支气管黏膜淤血<span style="color: black;">导致</span>，<span style="color: black;">起始</span>常于夜间<span style="color: black;">出现</span>，坐位或立位时咳嗽可减轻，白色浆液性<span style="color: black;">泡泡</span>状痰为其特点，偶可见痰中带血丝，急性左心衰<span style="color: black;">爆发</span>时可<span style="color: black;">显现</span>粉红色<span style="color: black;">泡泡</span>样痰。<span style="color: black;">长时间</span>慢性肺淤血肺静脉压力<span style="color: black;">上升</span>，<span style="color: black;">引起</span>肺循环和支气管血液循环之间在支气管黏膜下形成侧支，此种血管一旦破裂可<span style="color: black;">导致</span>大咯血。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.乏力、心累、活动后气促：乏力、疲倦、运动耐量减低、<span style="color: black;">头昏</span>、心慌等器官和组织灌注不足，以及代偿性心率加快<span style="color: black;">导致</span>的症状。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.少尿及肾功能损害症状：严重的左心衰竭血液进行再分配时，肾血流量<span style="color: black;">首要</span>减少，可<span style="color: black;">显现</span>少尿。<span style="color: black;">长时间</span>慢性的肾血流量减少可<span style="color: black;">显现</span>血尿素氮、肌酐<span style="color: black;">上升</span>，并可有肾功能不全的相应症状。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.胃肠道症状：胃肠道及肝淤血<span style="color: black;">导致</span>腹胀、食欲不振、恶心、呕吐等是右心衰最<span style="color: black;">平常</span>的症状。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6.其他症状：部分老年<span style="color: black;">病人</span>还有迟钝、记忆力<span style="color: black;">衰退</span>、思维<span style="color: black;">错乱</span>，<span style="color: black;">乃至</span>精神<span style="color: black;">阻碍</span>等表现。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：</span><span style="color: black;">心力衰竭的<span style="color: black;">害处</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭的<span style="color: black;">害处</span><span style="color: black;">重点</span>有生活质量下降、食欲<span style="color: black;">衰退</span>、<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>、电</span><span style="color: black;">解质<span style="color: black;">错乱</span>等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.心力衰竭<span style="color: black;">病人</span>有<span style="color: black;">显著</span>的心脏泵血功能<span style="color: black;">阻碍</span>和心肌收缩乏力，<span style="color: black;">没</span></span><span style="color: black;">法进行体力活动、<span style="color: black;">不可</span>从事有<span style="color: black;">必定</span>劳动量和压力的工作，并且<span style="color: black;">长时间</span>需</span><span style="color: black;">要用药治疗，<span style="color: black;">增多</span>经济<span style="color: black;">包袱</span><span style="color: black;">引起</span>生活质量下降。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.心力衰竭<span style="color: black;">引起</span>胃部淤血，影响胃酸分泌和消化功能的，<span style="color: black;">引起</span>食</span><span style="color: black;">欲<span style="color: black;">衰退</span>，严重者会<span style="color: black;">导致</span>营养不良。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.<span style="color: black;">摄食</span>减少、应用利尿剂治疗心力衰竭，会<span style="color: black;">引起</span>电解质<span style="color: black;">错乱</span>，尤</span><span style="color: black;">其是使血钾浓度降低，有可能诱发<span style="color: black;">心率</span>失常、<span style="color: black;">引起</span>心跳骤停。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：平常有<span style="color: black;">那些</span>常用<span style="color: black;">检测</span><span style="color: black;">办法</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.</span><span style="color: black;">实验室<span style="color: black;">检测</span>：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">1）利钠肽：</span><span style="color: black;">是心衰诊断、病人管理、临床事件<span style="color: black;">危害</span><span style="color: black;">评定</span>的<span style="color: black;">要紧</span>指标。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">2）肌钙蛋白：</span><span style="color: black;">严重心衰或心衰失代偿期、败血症等病人肌钙蛋白可轻微<span style="color: black;">升高</span>，但其更<span style="color: black;">要紧</span>的目的是<span style="color: black;">知道</span><span style="color: black;">可否</span>存在急性冠脉综合</span><span style="color: black;">征</span><span style="color: black;">。</span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">3）常规<span style="color: black;">检测</span>：</span><span style="color: black;">血常规、肝肾功能、血脂、电解质、甲状腺功能。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">2.心电图<span style="color: black;">检测</span>：</span><span style="color: black;">心力衰竭<span style="color: black;">没</span>特异性心电图，但能<span style="color: black;">帮忙</span>判断心肌缺血、既往心肌梗死、传导阻滞、<span style="color: black;">心率</span>失常等，<span style="color: black;">供给</span>客观依据。</span></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">3.超声</span><span style="color: black;">心</span><span style="color: black;">动图：</span><span style="color: black;">更准确</span><span style="color: black;">的</span><span style="color: black;"><span style="color: black;">评估</span>各心腔<span style="color: black;">体积</span>变化及瓣膜结构和功能，方便快捷的<span style="color: black;">评定</span>心功能和判断病因，是诊断心力衰竭最<span style="color: black;">重点</span>的仪器<span style="color: black;">检测</span>。</span></span></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">4.X线<span style="color: black;">检测</span>：</span><span style="color: black;">是确诊左心衰竭肺水肿的<span style="color: black;">重点</span>依据，并有助于心衰和肺部<span style="color: black;">疾患</span>的鉴别。</span></span></span></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰<span style="color: black;">害处</span>大，<span style="color: black;">怎样</span><span style="color: black;">才可</span><span style="color: black;">即时</span><span style="color: black;">发掘</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">初期</span>心衰的表现并不典型，有的<span style="color: black;">病人</span>会在进行较为剧烈的活动时</span></span></span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">显现</span>气短，上楼时胸闷、气短，<span style="color: black;">休憩</span>后<span style="color: black;">就可</span>缓解。有的<span style="color: black;">夜晚</span>入睡后憋</span></span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">气及胸闷，需用好几个枕头垫高才舒服，每晚双下肢浮肿、疲乏<span style="color: black;">没</span></span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">力、<span style="color: black;">头昏</span>、记忆力下降等。假如<span style="color: black;">显现</span><span style="color: black;">以上</span>症状，可进行<span style="color: black;">有些</span>常规<span style="color: black;">检测</span></span></span></span><span style="color: black;"><span style="color: black;">心电图、心脏超声，是临床常用最简便、快捷的<span style="color: black;">办法</span>。还有<span style="color: black;">有些</span>隐性</span></span><span style="color: black;">心衰者自己并未感觉<span style="color: black;">尤其</span>异样，如不是心脏超声等<span style="color: black;">检测</span><span style="color: black;">显示</span>其心脏增</span><span style="color: black;">大、功能减弱，这些<span style="color: black;">病人</span>几乎与最佳的治疗时期擦肩而过。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰<span style="color: black;">怎样</span>治疗？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰治疗<span style="color: black;">重点</span><span style="color: black;">包括</span><span style="color: black;">通常</span>治疗、<span style="color: black;">药品</span>治疗和非<span style="color: black;">药品</span>治疗。</span><span style="color: black;">重点说一下<span style="color: black;">通常</span>治疗与<span style="color: black;">药品</span>治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">通常</span>治疗：</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 生活方式管理</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)病人教育:心衰病人及家属应得到准确的<span style="color: black;">相关</span><span style="color: black;">疾患</span>知识和管理的<span style="color: black;">指点</span>，内容<span style="color: black;">包含</span>健康的生活方式、<span style="color: black;">安稳</span>的<span style="color: black;">心情</span>、适当的诱因规避、规范的<span style="color: black;">药品</span><span style="color: black;">吃下</span>、<span style="color: black;">恰当</span>的随访计划等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)体重管理:<span style="color: black;">平常</span>体重监测能简便直观地反映病人体液潴留<span style="color: black;">状况</span>及利尿剂疗效,<span style="color: black;">帮忙</span><span style="color: black;">指点</span><span style="color: black;">调节</span>治疗<span style="color: black;">方法</span>。体重改变<span style="color: black;">常常</span>出<span style="color: black;">此刻</span>临床体液潴留症状和体征之前。部分严重慢性心力衰竭病人存在临床或亚临床营养不良，若病人<span style="color: black;">显现</span><span style="color: black;">海量</span>体脂丢失或干重减轻<span style="color: black;">叫作</span>为心源性恶病质,<span style="color: black;">常常</span>预示预后不良。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(3)<span style="color: black;">膳食</span>管理:心衰病人血容量<span style="color: black;">增多</span>,<span style="color: black;">身体</span>水钠潴留,减少钠盐摄入有利于减轻<span style="color: black;">以上</span><span style="color: black;">状况</span>，但在应用强效排钠利尿剂时过分严格限盐可<span style="color: black;">引起</span>低钠血症。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.<span style="color: black;">休憩</span>与活动急性期或病情不稳定者应限制体力活动，卧床<span style="color: black;">休憩</span>，以降低心脏负荷,有利于心功能的恢复。但<span style="color: black;">长时间</span>卧床易<span style="color: black;">出现</span>深静脉血栓形成<span style="color: black;">乃至</span>肺栓塞，<span style="color: black;">同期</span><span style="color: black;">亦</span>可能<span style="color: black;">显现</span>消化功能减低、肌肉萎缩、坠积性肺炎、压疮等，适宜的活动能<span style="color: black;">加强</span>骨骼肌功能，改善活动耐量。<span style="color: black;">因此呢</span>，应鼓励病情稳定的心衰病人主动运动，<span style="color: black;">按照</span>病情轻重不同，在不诱发症状的前提下从床边小坐<span style="color: black;">起始</span>逐步<span style="color: black;">增多</span>有氧运动。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.病因治疗</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)病因治疗:对所有可能<span style="color: black;">引起</span>心脏功能受损的<span style="color: black;">平常</span><span style="color: black;">疾患</span>如高血压、冠心病、糖尿病、代谢<span style="color: black;">综合症</span>等,在尚未<span style="color: black;">导致</span>心脏器质性改变前即应<span style="color: black;">初期</span>进行有效治疗。<span style="color: black;">针对</span><span style="color: black;">少许</span>病因未明的<span style="color: black;">疾患</span>如原发性扩张型心肌病等<span style="color: black;">也</span>应<span style="color: black;">初期</span>积极<span style="color: black;">干涉</span>，延缓<span style="color: black;">疾患</span><span style="color: black;">发展</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)消除诱因:<span style="color: black;">平常</span>的诱<span style="color: black;">由于</span>感染，<span style="color: black;">尤其</span>是<span style="color: black;">呼气</span>道感染，应积极<span style="color: black;">选择</span>适当的抗感染治疗。快心室率心房颤动应尽快<span style="color: black;">掌控</span>心室率，如有可能应<span style="color: black;">即时</span>复律。应<span style="color: black;">重视</span>排查及纠正潜在的甲状腺功能<span style="color: black;">反常</span>贫血等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">药品</span>治疗：</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心衰病人在用药的时候不仅要消除水肿，减少血容量来减轻心脏前负荷，<span style="color: black;">况且</span><span style="color: black;">经过</span>降低血压来减轻心脏后负荷。利尿药是必不可少的<span style="color: black;">药品</span>，有氢氯噻嗪、呋塞米、螺内酯。利尿药<span style="color: black;">通常</span>和血管紧张素转换酶<span style="color: black;">控制</span>剂，β受体阻滞剂联合应用，这<span style="color: black;">便是</span><span style="color: black;">咱们</span>熟知的“金三角”，在“金三角”<span style="color: black;">方法</span>中，与传统的普利类相比，沙库巴曲缬沙坦（ARNI）可使心衰<span style="color: black;">病人</span>心血管死亡事件<span style="color: black;">危害</span>降低20%，因心衰住院<span style="color: black;">危害</span><span style="color: black;">亦</span>降低了21%，<span style="color: black;">这里</span><span style="color: black;">基本</span>上，加用达格列净可使<span style="color: black;">病人</span>心血管死亡<span style="color: black;">危害</span><span style="color: black;">明显</span>下降18%，恩格列净可使<span style="color: black;">危害</span>降低31%。<span style="color: black;">因此呢</span>呢，<span style="color: black;">咱们</span>心衰用药，从“金三角”升为“新四联”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">问：心衰<span style="color: black;">病人</span>平常生活<span style="color: black;">怎样</span>实现自我管理？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、<span style="color: black;">恰当</span><span style="color: black;">休憩</span>：除午休外，下午宜<span style="color: black;">增多</span>数小时卧床<span style="color: black;">休憩</span>。急性期和重症心衰<span style="color: black;">病人</span>应卧床<span style="color: black;">休憩</span>，<span style="color: black;">小心</span>功能好转后，应下床进行适当活动，如散步等，但要<span style="color: black;">把握</span>活动量，当脉搏大于110次/分或感到有心慌、气急与异搏感时，应停止活动并<span style="color: black;">休憩</span>。切忌活动<span style="color: black;">太多</span>、过猛，更<span style="color: black;">不可</span>参加较剧烈的活动，<span style="color: black;">以避免</span>心力衰竭<span style="color: black;">忽然</span>加重。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2、减少诱因：<span style="color: black;">疲劳</span>、感染是诱发心衰的<span style="color: black;">平常</span><span style="color: black;">原由</span>，对慢性心衰病人来讲，<span style="color: black;">没</span>论遇到何种感染，均应<span style="color: black;">初期</span>应用足量抗生素。体弱<span style="color: black;">病人</span>有感染时，体温不<span style="color: black;">必定</span>很高，可能只表现为倦怠、嗜睡、食欲不振等，应<span style="color: black;">重视</span>观察。减少劳力<span style="color: black;">原因</span>，保持排便通畅。<span style="color: black;">重视</span>预防感冒，在感冒流行季节或气候骤变<span style="color: black;">状况</span>下，<span style="color: black;">病人</span>要减少外出，出门应戴口罩并适当增添衣服，<span style="color: black;">病人</span>还应少去人群密集之处。<span style="color: black;">病人</span>若<span style="color: black;">出现</span><span style="color: black;">呼气</span>道感染，则非常容易使病情急剧恶化。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3、<span style="color: black;">调节</span><span style="color: black;">膳食</span>：其原则为低钠（盐）、低热量、清淡而易消化，<span style="color: black;">重视</span>摄入足量的碳水化合物、足量维生素、<span style="color: black;">没</span>机盐、适量脂肪，并应戒烟戒酒，最好少食多餐，避免因饱餐而加重或诱发心衰。<span style="color: black;">膳食</span>应清淡、易消化、少刺激。禁用浓茶、咖啡或辣椒等，多吃<span style="color: black;">鲜嫩</span>蔬菜、<span style="color: black;">果蔬</span>、豆制品。要少量多餐，不宜过饱，<span style="color: black;">以避免</span>加重心脏<span style="color: black;">包袱</span>，要<span style="color: black;">掌控</span><span style="color: black;">每日</span>的食盐量，水分<span style="color: black;">亦</span>不宜<span style="color: black;">太多</span>，心力衰竭时，病人<span style="color: black;">显现</span>水肿的<span style="color: black;">原由</span>是静脉和微血管淤血，细胞外液<span style="color: black;">增多</span>和钠盐潴留，<span style="color: black;">因此呢</span>，适当<span style="color: black;">掌控</span>钠盐摄入极为<span style="color: black;">要紧</span>。<span style="color: black;">一般</span><span style="color: black;">食品</span>应<span style="color: black;">选取</span><span style="color: black;">饱含</span>必需氨基酸的<span style="color: black;">优秀</span>蛋白，如牛奶、瘦肉、淡水鱼等。要戒烟戒酒。勿暴饮暴食，宜少食多餐，尤其是晚餐勿吃得过饱，<span style="color: black;">以避免</span><span style="color: black;">增多</span>心脏<span style="color: black;">包袱</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、<span style="color: black;">保持</span>治疗：要严格按医嘱用药，不可擅自停药或换药，<span style="color: black;">以避免</span><span style="color: black;">诱发</span>严重不良后果；要熟悉常用<span style="color: black;">药品</span>的毒副<span style="color: black;">功效</span>，以利于早<span style="color: black;">发掘</span>早治疗。<span style="color: black;">吃下</span>洋地黄类<span style="color: black;">药品</span>时，应<span style="color: black;">重视</span>毒性反应。<span style="color: black;">每日</span><span style="color: black;">吃下</span>前要<span style="color: black;">测绘</span>一下脉搏。服药后<span style="color: black;">显现</span>恶心、呕吐、腹泻、乏力、视力有改变，看东西发黄，脉搏<span style="color: black;">错乱</span>，心跳不规则，是洋地黄的中毒反应，应立即停药，并前去医院<span style="color: black;">检测</span>治疗。<span style="color: black;">吃下</span>利尿剂时，要观察尿量，<span style="color: black;">通常</span>应用的双氢克尿噻或呋塞米，在利尿的<span style="color: black;">同期</span><span style="color: black;">亦</span>使病人排出相当数量的钾离子，<span style="color: black;">因此</span><span style="color: black;">吃下</span>时<span style="color: black;">通常</span>要<span style="color: black;">同期</span><span style="color: black;">重视</span><span style="color: black;">弥补</span>钾。为了减少<span style="color: black;">药品</span>对胃的刺激，可在饭后<span style="color: black;">吃下</span>或加些果汁<span style="color: black;">一块</span><span style="color: black;">吃下</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5、要保持大便畅通：还要使病人生活规律，<span style="color: black;">心情</span>稳定，精神愉快，避免紧张、激动。<span style="color: black;">尤其</span>要<span style="color: black;">重视</span>养成<span style="color: black;">按时</span>排便习惯，保持大便通畅。便秘常会<span style="color: black;">导致</span>病人焦虑和紧张，用力排便又可使心力衰竭加重，<span style="color: black;">乃至</span>有<span style="color: black;">引起</span>猝死的危险。如有习惯性便秘，可适当<span style="color: black;">吃下</span>缓泻剂，如番泻叶煎茶喝，每日3g ；或取百合250g，蜂蜜适量，将百合加适量清水炖成糊状，加入蜂蜜拌匀后食用，每日一次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6、<span style="color: black;">保持</span>健康的生活方式：<span style="color: black;">必定</span>要戒烟、限酒，不喝浓茶或咖啡。保持<span style="color: black;">心理</span>平衡，不让<span style="color: black;">心情</span>过于兴奋波动，<span style="color: black;">同期</span>还要<span style="color: black;">保准</span>充足的<span style="color: black;">睡觉</span>。慢性心衰病人，应保持平和<span style="color: black;">心理</span>，不要自寻<span style="color: black;">懊恼</span>。生活上<span style="color: black;">不外</span>分依赖别人，但<span style="color: black;">亦</span>不要逞强。对自己的病情，应<span style="color: black;">注意</span>，但<span style="color: black;">亦</span>不要过分关注，<span style="color: black;">以避免</span>因过于紧张而诱发急性心衰。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7、要做好<span style="color: black;">自己</span>监测:心衰者平时<span style="color: black;">必定</span>要<span style="color: black;">重视</span>观察自己脉搏、血压、面色、尿量、体重的变化。最好<span style="color: black;">每日</span>（排尿后）同一时间<span style="color: black;">叫作</span>体重，穿类似重量的衣服。夜晚睡觉前应观察踝部<span style="color: black;">可否</span>肿胀，夜间<span style="color: black;">睡觉</span><span style="color: black;">可否</span>有被憋醒感。<span style="color: black;">重视</span><span style="color: black;">每日</span>的尿量，最好用容器收集一天的尿量：当<span style="color: black;">显现</span>心慌、咳嗽、<span style="color: black;">呼气</span>困难、难以平卧、浮肿、恶心、呕吐、尿量减少，一天之内体重<span style="color: black;">增多</span>1000克以上，说明心衰病加重，应立即去医院就诊，以便<span style="color: black;">大夫</span><span style="color: black;">即时</span><span style="color: black;">调节</span>治疗<span style="color: black;">方法</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8、<span style="color: black;">定时</span>随访复查：心衰的治疗是一个<span style="color: black;">长时间</span>的过程，病情稳<span style="color: black;">按时</span>每隔2-3周<span style="color: black;">必要</span>到心衰门诊<span style="color: black;">或</span>心血管科的专家门诊就诊，<span style="color: black;">即时</span>调药，并<span style="color: black;">定时</span>做检验<span style="color: black;">检测</span>。<span style="color: black;">包含</span>心电图、心功能测定、体重与水肿<span style="color: black;">状况</span>，还要<span style="color: black;">重视</span><span style="color: black;">定时</span>抽血复查地高辛浓度和血钾、钠、镁以及尿素氮、肌酐等，若<span style="color: black;">发掘</span><span style="color: black;">反常</span>，要<span style="color: black;">即时</span><span style="color: black;">看病</span>。</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">李万能</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/sz_mmbiz_jpg/C1PyZNmGHiaKbguh1UURq2ibPF8YRaKTibxVKqd5QJSflOb07GuuJ5oA8oGKfJZnqt35rktfeyNft3mxC9ghg568Q/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">毕节市</span><span style="color: black;">七星关区人民医院内科负责人，毕业于贵阳医学院，毕业后</span><span style="color: black;">从事心血管内科工作。曾先后于温州医科大学<span style="color: black;">附庸</span>医院、贵州医科大学<span style="color: black;">附庸</span>医院心内科<span style="color: black;">学习</span>，2022年于贵州省人民医院参加卫生部组织的冠脉资质培训，取得资质，能独立<span style="color: black;">熟悉</span>处理心内科<span style="color: black;">平常</span>病、多发病的诊疗，以及疑难重症的诊治，<span style="color: black;">善于</span>心脏介入治疗。</span>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">来 源：<span style="color: black;">FM912《健康合伙人》栏目</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">编 辑：文 丹</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一 审：张 玲</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">二 审：李德恭</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">三 审：刘咏梅</p><img src="https://mmbiz.qpic.cn/mmbiz_png/bL2iaicTYdZn6IsibG5fWiaicOJee1OcXPV5eWzOHbgyIxcbn1icAwy6iaYN2lYNIoCpHQltb4Fad1TyHEcUatMjJne4w/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/C1PyZNmGHiaKRZe79oeAF9x7qHJQ8uqWxibzgewev2pkssicII3YwjlHu4QtMLFia0HwLllf9p2rEaMJo9mAIWsYzg/640?wx_fmt=jpeg&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">长按识别二维码</strong></p>
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