从指南看心衰进展.ppt

慢性心衰治疗药物清单 改善预后：适用于所有慢性收缩性心衰心功能Ⅱ~Ⅳ级患者 血管紧张素转化酶抑制剂（ACEI）（Ⅰ，A） β受体阻滞剂（Ⅰ，A） 醛固酮拮抗剂（Ⅰ，A） 血管紧张素受体拮抗剂（ARB）（Ⅰ，A） 伊伐布雷定：用来降低因心衰再住院率（Ⅱa，B），替代用于不能耐受β受体阻滞剂的患者（Ⅱb，C）。 可改善症状的药物：??推荐应用于所有慢性收缩性心衰心功能Ⅱ～Ⅳ级患者： 利尿剂（Ⅰ，C） 地高辛（Ⅱa，B） 醛固酮拮抗剂适用人群扩大? 此类药传统上仅用于 NYHA Ⅲ～Ⅳ级患者。醛固酮拮抗剂适用人群扩大至所有伴有症状（NYHA Ⅱ～Ⅳ级） 指南原文： suspected AHF makes the diagnosis unlikely (thresholds: BNP ﹤100 pg/mL, NT-proBNP ﹤300 pg/mL,MR-proANP ﹤120 pg/mL). * 指南原文： However, elevated levels of NPs do not automatically confirm the diagnosis of AHF, as they may also be associated with a wide variety of cardiac and non-cardiac causes * 充血表现：肺充血，端坐呼吸，外周水肿，颈静脉扩张，充血性肝肿大，肠道淤血，腹水，肝颈静脉回流等 低灌注表现：四肢冷汗，少尿，精神混乱，头晕等 低灌注不等同于低血压，但低灌注常伴随低血压 * 指南原文： 1 Clinical classification can be based on bedside physical examination in order to detect the presence of clinical symptoms/signs of congestion(‘wet’ vs. ‘dry’ if present vs. absent) and/or peripheral hypoperfusion(‘cold’ vs. ‘warm’ if present vs. absent) 2 The combination of these options identifies four groups: warm and wet (well perfused and congested) —most commonly present; cold and wet (hypoperfused and congested); cold and dry (hypoperfused without congestion); and warm and dry (compensated, well perfused without congestion). 3 This classification may be helpful to guide therapy in the initial phase and carries prognostic information * 1.依据识别急性病因早期启动适当治疗（an early initiation of appropriate therapy）的概念，遵循急性冠脉综合征(ACS)确立的“最佳治疗时间”（time to therapy）方法。 2.基于是否存在充血和/或低灌注的临床特征，将AHF分为四类，并据此确定AHF诊疗的新流程 3.对于没有症状性低血压的急性心衰患者SBP＞90mmHg推荐应用血管扩张剂减轻症状。（2012版SBP＞110mmHg ） * 指南原文： Intravenous vasodilators (Table) are the second most often used agents in AHF for symptomatic relief; They have dual benefit by decreasing venous tone (to optimize preload) and arterial tone (decrease afterload). * 早期在急诊、ICU或CCU,稳定后转入普通病房，制定出院管理计划，制定随访计划。 * 指南原文: For high-risk patients (i.e. with persistent, significant dyspnoea,haemodynamic instability, recurrent arrhythmias, AHF and associated ACS), initial care should be provid