心力衰尽时会有哪些表现？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/7VjJWiaQ26fVYgPEJAs2TUKO1W7W9eNKhdFQRDrC696bol8pnj5Haza8wDhwJia0fkIFfS0Tbg5uaDYzOKesaKqA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></span></a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">共有这三类的心衰：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心衰<span style="color: black;">根据</span><span style="color: black;">显现</span>的位置可分为左心衰、右心衰和全心衰；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">根据</span>病情发展的快慢分为急性心衰和慢性心衰。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1 . 左心衰</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">左心衰最<span style="color: black;">重点</span>的表现<span style="color: black;">便是</span><span style="color: black;">逐步</span>加重的<span style="color: black;">呼气</span>困难，<span style="color: black;">初期</span>表现<span style="color: black;">包含</span>： </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1 ）<span style="color: black;">劳动或上楼梯时的<span style="color: black;">呼气</span>困难，</span>是左心<span style="color: black;">衰尽</span>的最早和最<span style="color: black;">平常</span>的症状，<span style="color: black;">重点</span><span style="color: black;">因为</span>急性或慢性肺淤血和肺活量减低所<span style="color: black;">导致</span>。轻者仅于较重的体力劳动时<span style="color: black;">出现</span><span style="color: black;">呼气</span>困难，<span style="color: black;">休憩</span>后<span style="color: black;">火速</span>消失，故<span style="color: black;">叫作</span>为劳力性<span style="color: black;">呼气</span>困难。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2 ）<span style="color: black;"><span style="color: black;">睡觉</span>时<span style="color: black;">忽然</span><span style="color: black;">呼气</span>困难，坐起后有好转，</span><span style="color: black;">叫作</span>为夜间阵发性<span style="color: black;">呼气</span>困难。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3 ）<span style="color: black;">咳嗽，常<span style="color: black;">出现</span>在夜间，</span>坐位或立位时可减轻或停止。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4 ）<span style="color: black;">体力下降、乏力和虚弱。</span>严重心衰可发展成肺水肿，咯<span style="color: black;">海量</span><span style="color: black;">泡泡</span>状血痰，血压可下降，<span style="color: black;">乃至</span>休克，此时需紧急就诊。</p><img src="https://mmbiz.qpic.cn/mmbiz_png/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEbwV30eyecVpefRVAV2DIXZnicTK3u9w8Q9dqNfjeakfpIOLPZ3kRacMA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" 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;"> 2. 右心衰</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1 ）<span style="color: black;">胃肠道症状：</span>右心<span style="color: black;">衰尽</span>的表现<span style="color: black;">重点</span>是<span style="color: black;">因为</span>体循环淤血<span style="color: black;">导致</span>，<span style="color: black;">包含</span>胃肠道淤血可<span style="color: black;">导致</span>上腹部胀满、食欲不振、恶心、呕吐等，肝脏充血可<span style="color: black;">导致</span>肝肿大并有压痛，<span style="color: black;">长时间</span>慢性肝淤血缺氧，可<span style="color: black;">导致</span>肝细胞变性、坏死、<span style="color: black;">最后</span>发展为心源性肝硬化，肝功能不正常或<span style="color: black;">显现</span>黄疸。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2 ）<span style="color: black;">水肿：</span>右心<span style="color: black;">衰尽</span><span style="color: black;">初期</span>，<span style="color: black;">因为</span><span style="color: black;">身体</span>先有钠、水潴留，故在水肿<span style="color: black;">显现</span>前可先有体重的<span style="color: black;">增多</span>，体液潴留达五<span style="color: black;">千克</span>以上时才<span style="color: black;">显现</span>水肿。水肿多先见于双下肢，多于傍晚<span style="color: black;">显现</span>或加重，<span style="color: black;">休憩</span><span style="color: black;">一晚上</span>后可减轻或消失，常伴有夜间尿量的<span style="color: black;">增多</span>。卧床病人常有腰、背及骶部等低垂部位<span style="color: black;">显著</span>凹陷性水肿，重症者可波及全身，水肿严重时可有胸水和腹水。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3 ）<span style="color: black;">紫绀：</span>右心<span style="color: black;">衰尽</span>者多有不同程度的紫绀，最早见于指端、口唇和耳廓，比左心<span style="color: black;">衰尽</span>者<span style="color: black;">显著</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4 ）<span style="color: black;">神经系统症状：</span>可有神经过敏、失眠、嗜睡等症状。重者可<span style="color: black;">出现</span>精神错乱，可能<span style="color: black;">因为</span>脑淤血、缺氧或电解质<span style="color: black;">错乱</span>等<span style="color: black;">原由</span><span style="color: black;">导致</span>。</p><img src="https://mmbiz.qpic.cn/mmbiz_png/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEbn8YxEym4lphvfIibb3KeAialNLMx0vmYgp0l2ticM5kEsibKjd3ibiaLTOgA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" 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;">3. 全心<span style="color: black;">衰尽</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">全心<span style="color: black;">衰尽</span>可<span style="color: black;">同期</span>存在左、右心<span style="color: black;">衰尽</span>的临床表现，<span style="color: black;">亦</span><span style="color: black;">能够</span>左或右心<span style="color: black;">衰尽</span>的临床表现为主。</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;">心衰病例<span style="color: black;">1、</span>咳嗽<span style="color: black;">亦</span>要<span style="color: black;">警觉</span>心衰！</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">许阿姨今年 6 8 岁，平时有高血压<span style="color: black;">数年</span>，<span style="color: black;">无</span>任何不舒服，<span style="color: black;">始终</span><span style="color: black;">无</span><span style="color: black;">保持</span>治疗，血压最高时曾达到 1 8 0 / 1 1 0 m m H g ，偶尔难受时吃两天降压药。近两个月来，许阿姨经常在夜间平卧后咳嗽，仅有少量白痰，咳醒后起来活动活动就好了，吃过消炎药<span style="color: black;">亦</span>没用。近<span style="color: black;">1星期</span>经常在走路快时或爬<span style="color: black;">3、</span>四层楼梯时感到气喘、疲劳，<span style="color: black;">必须</span>停下<span style="color: black;">休憩</span>一会儿，并且这种<span style="color: black;">状况</span><span style="color: black;">逐步</span>加重。今天有时间顺便来医院看病，结果<span style="color: black;">大夫</span>说许阿姨得了心衰。许阿姨很奇怪，自己身体一向很好啊，怎么就忽然心衰了呢？</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;">病情分析</span></strong>：许阿姨的高血压<span style="color: black;">数年</span>，<span style="color: black;">无</span>正规治疗过。<span style="color: black;">高血压容易<span style="color: black;">引起</span>左室肥厚，<span style="color: black;">初期</span>是一种代偿性的反应，<span style="color: black;">逐步</span>发展就会影响心功能<span style="color: black;">显现</span>心衰，是我国<span style="color: black;">导致</span>心衰的第二大病因。</span><span style="color: black;">咳嗽是心衰<span style="color: black;">初期</span>的症状之一，夜间平卧后回到心脏的血液容量<span style="color: black;">增加</span>，肺脏内的体液<span style="color: black;">太多</span>，垫高枕头或坐起时可<span style="color: black;">经过</span>重力<span style="color: black;">功效</span>使血液<span style="color: black;">滞留在下肢，暂时减轻症状。</span></span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEboMaXyPksiaj9yRyM7yYexCdeia7zRUicRme5icRPIBNniccxTcJcfuN9ibOQ/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;"><strong style="color: blue;"><span style="color: black;">心衰病例<span style="color: black;">2、</span>病情稳定<span style="color: black;">亦</span>要小心！</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">王大伯今年 5 8 岁了，八年前<span style="color: black;">发掘</span>了扩张型心肌病，<span style="color: black;">保持</span>应用<span style="color: black;">药品</span>治疗后体力恢复非常好，能够正常上班、<span style="color: black;">熬炼</span>，每周末都要去郊区爬一次山，三天前王大伯有点感冒，咳嗽、咳痰、鼻塞，症状不重，<span style="color: black;">因此呢</span>今天<span style="color: black;">白日</span>就和以前<span style="color: black;">同样</span>和<span style="color: black;">伴侣</span>去爬山了。可<span style="color: black;">夜晚</span>回来后就觉得憋气、恶心，没吃晚饭，本来想躺一会就好了，可没想到憋气越来越重，到最后咳粉红色<span style="color: black;">泡泡</span>痰，连半躺着都不行，只能坐着，伴严重的烦躁。</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;">病情分析</span></strong>：<span style="color: black;">扩张型心肌病是<span style="color: black;">引起</span>心衰的一个<span style="color: black;">平常</span><span style="color: black;">原由</span>，<span style="color: black;">不可</span>治愈，<span style="color: black;">必须</span>终生应用<span style="color: black;">药品</span>治疗。</span>感染是<span style="color: black;">引起</span>心衰急性加重或复发的一个最<span style="color: black;">平常</span>的诱因。王大伯三天前感冒，为上<span style="color: black;">呼气</span>道感染，此次照常活动后就<span style="color: black;">引起</span>了心衰的急性<span style="color: black;">爆发</span>。急性心衰发病急，病情凶险，<span style="color: black;">必须</span>刻不容缓进行急救。<span style="color: black;"><span style="color: black;">首要</span>要让病人安静，减少恐惧躁动。有<span style="color: black;">前提</span>的马上吸氧（急性肺水肿时吸氧可<span style="color: black;">经过</span> 7 5 ％酒精溶液），松开领扣、裤带。让病人坐起或半卧，两下肢随床沿下垂。避免<span style="color: black;">海量</span>饮水，<span style="color: black;">同期</span>立即送病人去医院救治。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEb5b23LEnScVOscRLjQWF9DNDw8Jx1O2bKibA4V4fFQazick2GFH8sU4vQ/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEbvE8eBCwP3MwU6BhHyxnT7Tkwj697UIN4QRo9yXKA1c14g8BH0j0yZg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/WY7RRgic9qHs3qUP8hWUxK1p5ibnCOfqEb5b23LEnScVOscRLjQWF9DNDw8Jx1O2bKibA4V4fFQazick2GFH8sU4vQ/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><strong style="color: blue;"><span style="color: black;">更加多</span>问题</strong>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"> 1. 什么时候应该就诊 </strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">如前面所说的，心衰的症状<span style="color: black;">重点</span>是喘和肿，有高血压、冠心病等<span style="color: black;">基本</span><span style="color: black;">疾患</span>，<span style="color: black;">显现</span>典型的喘、肿的症状，<span style="color: black;">那样</span>就有<span style="color: black;">显现</span>心衰的可能性，<span style="color: black;">必须</span><span style="color: black;">即时</span><span style="color: black;">看病</span>。有些<span style="color: black;">病人</span>心衰的<span style="color: black;">初期</span>临床表现不典型，有的仅仅表现为心跳快，活动量不大就感觉心慌、气短，活动后感觉<span style="color: black;">尤其</span>累。还有的表现为不想吃饭，<span style="color: black;">或</span><span style="color: black;">摄食</span>稍微多一点就感到肚子胀、不消化，有些人<span style="color: black;">乃至</span>会认为是胃肠<span style="color: black;">疾患</span>而到消化科就诊。<span style="color: black;">另外</span>，还有人表现为反复<span style="color: black;">显现</span>的上<span style="color: black;">呼气</span>道感染，并且治疗效果<span style="color: black;">欠好</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;"> 2. 自我判断心衰重不重 </strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">临床上<span style="color: black;">针对</span>心脏功能状态的<span style="color: black;">评估</span>，<span style="color: black;">始终</span>采用美国心脏病学会制定的分级标准 , <span style="color: black;">按照</span>体力受限的程度来判断心衰的严重程度。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Ⅰ级是体力活动不受限，</span><span style="color: black;"><span style="color: black;">通常</span>体力活动不<span style="color: black;">导致</span>过度的乏力、心悸、气促等症状，<span style="color: black;">便是</span> <strong style="color: blue;">“ 动<span style="color: black;">亦</span>不喘 ” 。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Ⅱ级是轻度体力活动受限，</span><span style="color: black;">安静时<span style="color: black;">没</span>不舒服的表现，但<span style="color: black;">小于</span><span style="color: black;">平常</span>活动量就可<span style="color: black;">显现</span>乏力、心悸、气促等症状，<span style="color: black;">亦</span><span style="color: black;">便是</span> <strong style="color: blue;">“ 不动不喘 ”</strong> 。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Ⅲ级是体力活动<span style="color: black;">显著</span>受限，</span><span style="color: black;">安静时<span style="color: black;">没</span>不适，但轻微活动就<span style="color: black;">显现</span><span style="color: black;">以上</span>症状 — <strong style="color: blue;">“ 动则气喘 ” 。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Ⅳ级心衰最严重，</span><span style="color: black;"><span style="color: black;">病人</span><span style="color: black;">不可</span>进行任何体力活动，<span style="color: black;">休憩</span>时就有心衰或心绞痛症状，任何体力活动都加重不适 — <strong style="color: blue;">“ 不动<span style="color: black;">亦</span>喘 ” 。（END）</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">【昨日答案】</strong></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;">出现</span>心血管事件后，降低LDL的<span style="color: black;">目的</span>是：</span><strong style="color: blue;"><span style="color: black;">1.4mmol/l</span></strong></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;">源自</span>：</span><span style="color: black;">北医人民心脏<span style="color: black;">恢复</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">作者：</span><span style="color: black;">丁荣晶教授团队</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_png/7VjJWiaQ26fWb7icLZyzIuLXtnAAUvibFbUGanhicaUIkm5xqptf07XCVC6jIX1ntrqBquDdvANRdE1MB8fIO6hLpg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
期待与你深入交流，共探知识的无穷魅力。
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