慢性心力衰竭的康复治疗.pptVIP

CHF患者随访管理 心衰管理模式日益进展 患者教育和自我管理 家庭访视 结构化电话支持系统 外置或置入式装置的远程监测 总 结 CHF是心脏病治疗的最后战场 注意运动训练的适应证、禁忌证，制定个体化的运动处方 多学科管理和随访管理可以减少CHF的住院率 * 据我国50多家医院住院病历调查显示，心衰住院率虽然只占同期心血管病总住院病历的20％，但其死亡率却占40％，NYHA心功能Ⅳ级的心衰患者，1年存活率仅为50％[6]。 * This diagram is from Goodlin from 2009, published in JACC and describes the typical trajectory of most patients with heart failure. As you can see, there are 5 phases which I will discuss briefly. Phase 1 – This is time of diagnosis and onset of symptoms. Patients are placed on the appropriate medications and begin to feel better and respond to treatment. Phase 2 – This is a plateau time and because life expectancy is so difficult to predict, we often do not have the discussion during this phase because the patient appears to be doing well. Phase 3 – Periods of instability and deteriorating heart function begin to occur. There may be frequent hospitalizations and likely now is the time to place ICDs and cardiac resynchronization devices. Phase 4 – Patient begins to experience even more symptoms and advanced heart failure therapy such as transplant or VAD placement should be considered. Palliative care and Hospice should also be considered. If a transplant/VAD is placed, the patient could typically revert back to Phase 2. The reappearance of severe symptoms in both phases 3 and 4 should prompt us to discuss end of life care and issues with the patient before Phase 5 Phase 5 – This is the terminal phase and often progresses rapidly. Unless we have had the end of life discussion with the patient and their family, the care can become disorganized and panic can set in. It is not uncommon for the family to call 911 and have the patient end up in the hospital or having CPR and receiving treatments they did not want. * * * Performed on treadmill or cycle ergometer In addition to ECG. Steroids increase strength but not peak VO2, * 慢性心力衰竭的康复治疗 徐州医学院附属医院 李东野 2014-05 目 录 心力衰竭康复治疗的必要性 心力衰竭康复治疗的国际临床试验 心力衰竭康复治疗方案的实施 心力衰竭多学科管理及随访管理