我喘累怎么就心衰了，我还有救吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">点击<strong style="color: blue;"><span style="color: black;">蓝字</span></strong>关注<span style="color: black;">咱们</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/LINicJqyWBgUrcEXTAxibsibT8XyfDHFpeBXUBG3yZhDyfoRuQ6YJ825fQ0vM2w6s8Lx5o5ibd1ibViajBtA1P8T5sicw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgUcnLmqVuUhJSk4F3jZD7M1RcfX0icWwicOYcJDXvRK7WUslX6OktrIIvgqHUbstIv4S21EjqxUYGkQ/640?wx_fmt=jpeg&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;"><span style="color: black;">经常有<span style="color: black;">病人</span>来到心内科门诊，开口就说：唉，<span style="color: black;">大夫</span>，我<span style="color: black;">近期</span>喘得很，以前能爬好几层楼，<span style="color: black;">此刻</span>走平路都累得不行。<span style="color: black;">大夫</span>一看，<span style="color: black;">病人</span>说话上气不接下气，双腿肿着，一听心跳快还不整齐，去做一个心脏超声，结果心脏增大了，<span style="color: black;">表率</span>心脏功能的射血分数降低了，于是<span style="color: black;">通知</span><span style="color: black;">病人</span>：你这是“心衰”了。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">听到这两个字，<span style="color: black;">病人</span>傻眼了，不禁问道：我喘累怎么<span style="color: black;">便是</span>心衰了，我还有救吗？</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;">心衰到底是怎么<span style="color: black;">导致</span>的，该<span style="color: black;">怎样</span>治疗？</span></strong></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;">今天<span style="color: black;">咱们</span>就<span style="color: black;">来讲</span>说。</span></strong></span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/YUyZ7AOL3on8Donfa40h4TgerNcN3XuI8a7MN54MxmbmamnOia3A8Z0IcTiayYz2ibaib0p5P9BrlibDialngDh92q7A/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;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">心衰，即心力衰竭</span></strong></span><span style="color: black;">，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></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;">简而言之，心衰是所有心血管<span style="color: black;">疾患</span>的终末<span style="color: black;">周期</span>，是心脏这个人体的发动机跳不动了。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">虽然心衰<span style="color: black;">能够</span>由多种心血管<span style="color: black;">疾患</span><span style="color: black;">导致</span>，但<strong style="color: blue;"><span style="color: black;">冠心病、高血压仍然是心衰最<span style="color: black;">重点</span>的病因，</span></strong><span style="color: black;">按照</span>2005年我国的病因调查，冠心病占57.1%居首位，高血压病占到了30.4%，其他还有风湿性心脏瓣膜病、扩张型心肌病等等。<strong style="color: blue;"><span style="color: black;">由此可见，冠心病、高血压等心血管<span style="color: black;">疾患</span><span style="color: black;">病人</span>做好<span style="color: black;">自己</span><span style="color: black;">疾患</span>管理以及心衰防治尤为<span style="color: black;">要紧</span>。</span></strong></span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/YUyZ7AOL3ony3BHsMvrBYHq1FUFSgRrbxFqlOe0FxjXPkpAmEm8EsazaLrUPSicKcHchYdTYV6lallbFNO2CiaibQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">那样</span>心衰的病人会有<span style="color: black;">那些</span>症状呢？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/LINicJqyWBgUcnLmqVuUhJSk4F3jZD7M1uTJ61cHNkibqtAXnr9bibssxV0lzWOurmc7Zw6GrVVeftmwrOreHGYyg/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;"><span style="color: black;">咱们</span><span style="color: black;">晓得</span>人体的血液循环分为体循环（外周动脉系统）和肺循环（肺动脉与<span style="color: black;">呼气</span>系统），<span style="color: black;"><strong style="color: blue;">左心</strong></span>的收缩将动脉血泵入体循环，滋养全身各个器官和组织，并将代谢产物及二氧化碳运回心脏；<span style="color: black;"><strong style="color: blue;">右心</strong></span>则<span style="color: black;">经过</span>收缩活动，将含氧少而含二氧化碳较多的静脉血泵入肺循环，<span style="color: black;">这里</span>进行血液的氧合，将血液再次变成含氧多的动脉血<span style="color: black;">供给</span>给左心，如此反复。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当冠心病、高血压等<span style="color: black;">各样</span>心血管<span style="color: black;">疾患</span><span style="color: black;">引起</span>心脏肥大<span style="color: black;">导致</span>左心衰时，左心射血的功能<span style="color: black;">衰退</span>，<span style="color: black;">没</span>法将从肺循环而来的血液泵入体循环，<span style="color: black;">引起</span>心脏排血量降低，<span style="color: black;">同期</span><span style="color: black;">导致</span>肺循环淤血。</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;">因为</span>肺淤血，<span style="color: black;">病人</span>会<span style="color: black;">显现</span>不同程度的<span style="color: black;">呼气</span>困难，其中最早<span style="color: black;">显现</span>的<span style="color: black;">便是</span>劳力性<span style="color: black;">呼气</span>困难，继之夜间阵发性<span style="color: black;">呼气</span>困难<span style="color: black;">乃至</span>端坐<span style="color: black;">呼气</span>。这<span style="color: black;">亦</span><span style="color: black;">便是</span>左心衰<span style="color: black;">病人</span>运动后会感到“喘累”的<span style="color: black;">原由</span>了。<span style="color: black;">另一</span>，<strong style="color: blue;"><span style="color: black;">除了不同程度的<span style="color: black;">呼气</span>困难，<span style="color: black;">因为</span>心脏的排血量下降，器官、组织灌注不足，左心衰的<span style="color: black;">病人</span><span style="color: black;">亦</span>会<span style="color: black;">显现</span>乏力、疲倦、<span style="color: black;">头昏</span>等症状。</span></strong></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;">病人</span>因<span style="color: black;">呼气</span>困难，其运动量<span style="color: black;">一般</span>会随着心衰程度的加重而减低，<span style="color: black;">因此</span><span style="color: black;">咱们</span><span style="color: black;">必须</span>对<span style="color: black;">病人</span>心衰的严重程度进行分级。临床上常用的是纽约心脏病学会的心功能分级（NYHF），可分为Ⅰ-Ⅳ四级。<strong style="color: blue;"><span style="color: black;">实质</span>生活中，<span style="color: black;">亦</span>可<span style="color: black;">经过</span>简单易行的6分钟步行<span style="color: black;">实验</span>来<span style="color: black;">评估</span>心衰严重程度。</strong><span style="color: black;">需求</span><span style="color: black;">病人</span>在平直走廊里尽快行走，测定6分钟的步行距离，若＞450米为轻度心衰，150-450米为中度心衰，＜150米则为重度心衰。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">同理，<span style="color: black;"><strong style="color: blue;">右心衰的<span style="color: black;">病人</span></strong></span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">因为</span>右心射血功能降低，则会出现以体循环淤血为主的症状，<span style="color: black;">包含</span>一系列<span style="color: black;">因为</span>胃肠道和肝脏淤血<span style="color: black;">导致</span>的腹胀、食欲不振、恶心、呕吐等消化道症状。</span></strong>查体可见身体低垂部位对<span style="color: black;">叫作</span>性的水肿，最<span style="color: black;">平常</span>的<span style="color: black;">便是</span>双下肢的凹陷性水肿，严重者腹腔和胸腔<span style="color: black;">亦</span>会积水。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">值得<span style="color: black;">重视</span>的是，单纯性的右心衰在临床上并不多见，<span style="color: black;">一般</span>是肺部疾患或先天性心脏病晚期右向左分流<span style="color: black;">导致</span>。大<span style="color: black;">都数</span>的右心衰继发于左心衰，<span style="color: black;">因此</span><span style="color: black;">针对</span><span style="color: black;">都数</span>右心衰<span style="color: black;">病人</span><span style="color: black;">来讲</span>，左心衰<span style="color: black;">导致</span>的<span style="color: black;">呼气</span>困难等症状业已存在。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/LINicJqyWBgUcnLmqVuUhJSk4F3jZD7M173f9lvsDe90XVh2nGibTmjSYsdfNopbYKAtOpOx5QLuQ6xUicWun8IibQ/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;"><span style="color: black;">图为心衰<span style="color: black;">病人</span>心脏增大，<span style="color: black;">显现</span><span style="color: black;">呼气</span>困难、</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">下肢水肿、紫绀等症</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/YUyZ7AOL3ony3BHsMvrBYHq1FUFSgRrbxFqlOe0FxjXPkpAmEm8EsazaLrUPSicKcHchYdTYV6lallbFNO2CiaibQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">那样</span>心衰该<span style="color: black;">怎样</span>治疗呢？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">以前<span style="color: black;">咱们</span>都认为心衰几乎是一个不可逆的过程，衰竭、<span style="color: black;">成长</span>的心脏<span style="color: black;">经过</span><span style="color: black;">药品</span>治疗只能延缓心衰的<span style="color: black;">发展</span>，但如今部分扩张型心肌病和高血压心衰<span style="color: black;">病人</span><span style="color: black;">经过</span>规范化的治疗，<strong style="color: blue;">尤其是<span style="color: black;">有些</span>新型的抗心衰<span style="color: black;">药品</span>如沙库巴曲缬沙坦、伊伐布雷定、钠葡萄糖协同转运蛋白2（SGLT-2）<span style="color: black;">控制</span>剂（列净类）等，以及抗心衰双心室起搏器等非<span style="color: black;">药品</span>治疗后，</strong></span><strong style="color: blue;"><span style="color: black;">扩大、衰竭的心脏是可能恢复正常的。</span></strong></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;">这是一个真实的病例：</span></strong><span style="color: black;">65岁男性，高血压病史10年，2018年7月20日初诊时诉上楼梯感觉心累气促，但走平路不累。心脏超声<span style="color: black;">检测</span>，提示左心房37毫米（正常≤35mm）、左心室66毫米（正常≤55mm）均增大，反映心脏射血功能的指标射血分数<span style="color: black;">仅有</span>40%（正常≥55%）。</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;">这是<span style="color: black;">由于</span>他<span style="color: black;">长时间</span><span style="color: black;">无</span>把血压<span style="color: black;">掌控</span>好，<span style="color: black;">最后</span><span style="color: black;">显现</span>了心脏扩大而<span style="color: black;">引起</span>了左心衰。</span></strong><span style="color: black;">在综合<span style="color: black;">思虑</span>之后，给他<span style="color: black;">药品</span><span style="color: black;">调节</span>为沙库巴曲缬沙坦、美托洛尔缓释片、呋塞米、螺内酯治疗，可以看到，<span style="color: black;">经过</span><span style="color: black;">逐步</span><span style="color: black;">调节</span>，规范诊治及随访，一年后，他的心脏各项指标<span style="color: black;">已然</span>完全恢复了正常，心衰的症状<span style="color: black;">亦</span>消失了，<span style="color: black;">逐步</span>能耐受强度更高的活动，从上楼梯感心累到不累，到<span style="color: black;">乃至</span>能耐受2<span style="color: black;">千米</span>的慢跑，<span style="color: black;">这般</span>的治疗<span style="color: black;">能够</span>说是非常成功的。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/LINicJqyWBgUcnLmqVuUhJSk4F3jZD7M1SibSDdYC8p5v259gqX0kLrzlD995V1YYg86Ulwrab3qIRGuicWu3by0A/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;"><span style="color: black;">除了<span style="color: black;">药品</span>治疗之外，<strong style="color: blue;">一部分符合<span style="color: black;">前提</span>的心衰<span style="color: black;">病人</span>还<span style="color: black;">能够</span>采用<span style="color: black;">有些</span>器械治疗的手段，<span style="color: black;">例如</span>心脏再同步化治疗，<span style="color: black;">亦</span><span style="color: black;">便是</span>三腔起搏器</strong>，但价格昂贵，<span style="color: black;">况且</span>还<span style="color: black;">必须</span><span style="color: black;">按照</span><span style="color: black;">病人</span>的病情来做<span style="color: black;">选取</span>。</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;">总之，冠心病、高血压等心血管慢病<span style="color: black;">病人</span><span style="color: black;">首要</span>要做好本身<span style="color: black;">疾患</span>的治疗和管理，预防或延缓心衰的<span style="color: black;">显现</span></span></strong>，一旦<span style="color: black;">显现</span>心衰的<span style="color: black;">关联</span>症状后要尽早去医院进行进一步的规范诊治。</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;">咱们</span>有理由相信<span style="color: black;">将来</span>部分心衰<span style="color: black;">病人</span>的生活质量会越来越高，预后会越来越好，心衰<span style="color: black;">再也不</span>是<span style="color: black;">不可</span>治愈的<span style="color: black;">疾患</span>了。</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;"> 往下看还没完 </span></strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/7QRTvkK2qC5GUbQCMws4DwCrakx3FiaDA57CMxiaWcSZKIa65Obg7ePmLUNOn0PHQnicRBmGFJIzxSFu0f9iaicFL0Q/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
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