AHAACC成人心力衰竭诊疗指南教材.ppt

Recommendations for the Hospitalized Patient – New Recommendations 2009 Focused Update Recommendations Class IIa 3. Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF Who have persistent symptoms despite empiric adjustment of standard therapies, and (对于经治疗症状仍持续存在的急性心衰,有创血流动力学监测是有用的) a. whose fluid status, perfusion, or SVR or PVR are uncertain(其容量,灌注,SVR或PVR 不明确者); b. whose systolic pressure remains low, or is associated with symptoms, despite initial therapy( 虽经初始治疗,收缩压低,且与症状相关); c. whose renal function is worsening with therapy(治疗中肾功能恶化); d. who require parenteral vasoactive agents or(需肠道外血管活性药物); e. who may need consideration for advanced device therapy or transplantation )(可能需要 器械治疗或移植). (Level of Evidence: C) 4. Ultrafiltration is reasonable for patients with refractory congestion not responding to medical therapy(顽固性充血经治疗无效超滤是合理的). (Level of Evidence: B) 住院心衰病人管理新推荐 Recommendations for the Hospitalized Patient – New Recommendations 2009 Focused Update Recommendations Class IIb 1. Intravenous inotropic drugs such as dopamine, dobutamine or milrinone MIGHT BE reasonable for those patients presenting with documented severe systolic dysfunction, low blood pressure and evidence of low cardiac output, with or without congestion, to maintain systemic perfusion and preserve end-organ performance. (Level of Evidence: C) 对于伴或不伴充血的严重收缩功能障碍、低 血压、低心排患者，静脉使用正性肌力药物如 多巴胺、多巴酚丁胺或米力农可能是合理的， 以维持全身灌注和保护靶器官功能。 住院心衰病人管理新推荐 Recommendations for the Hospitalized Patient – New Recommendations 2009 Focused Update Recommendations Class III 1. Use of parenteral inotropes in normotensive patients with acute decompensated HF without evidence of decreased organ perfusion is not recommended（对于无器官灌注不良的急性失代偿血压正常 患者，不推荐给予肠道外正性肌力药物）. (Level of Evidence: B) 2. Routine use of invasive hemodynamic monitoring in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and v