心力衰竭阶段划分诊断与治疗98例分析.docVIP

心力衰竭阶段划分诊断与治疗98例分析 　　 摘 要 临床上各种原因引起的心功能障碍称心功能不全；伴随呼吸困难、乏力、水肿的心功能不全即为心衰(包括左心衰、右心衰和全心衰)；是心脏病患者死亡的主要原因之一。早期准确地筛检出前心衰阶段(阶段A)和前临床心衰阶段(阶段B)的心脏病患者，给予门诊预防和治疗是降低当年内住院率和病死率的重要措施。其余的临床心衰阶段(阶段C)和难治性心衰阶段(阶段D)的患者给予住院合理治疗和纠正病因治疗，以改善生活质量和降低再住院率为目标。? 　　关键词 心衰诊断 阶段划分 治疗分析?? 　　doi:10.3969/j.issn.1007-614x.2012.03.127?? 　　Abstract Cardiac dysfunction caused by all kinds of reasons clinically often called cardiac insufficiency.Cardiac insufficiency with symptoms of dyspnea,exhausted and edema is also called heart failure,including left-side heart failure,right-side heart failure and both-sides heart failure.Heart failure is the leading death reason of most patients with cardiac diseases.First,screening early and accurately the cardiacs were wether in the pre-heart failure phase(phase A)and in the pre-clinical heart failure phase(phase B).In this stage,prevention and therapy with outpatient services was the important measures to lower the hospitalization rate and the fatality rate in that very year.The cardiacs in clinical heart failure phase(phase C)and non-therapy clinical heart failure(phase D)were hopitalized and given etiologic therapy;the main goal was to improve the quality of life and lower the re- hospitalization rate.In the paper,the experience of diagnosis and therapy of patients with cardiac insufficiency in our outpatient clinic and our in-patient department was introduced.? 　　Key Words Diagnosis of heart failure;Phase division;Analysis of therapy?? 　　现结合所在医院心内科门诊和住院部收治的各类心功能不全的患者将诊断与治疗体会作一简略介绍。? 　　资料与方法? 　　2009～2011年收治各种心脏病心功能不全患者98例，男64例(65.3%)，女34例(34.7%)；年龄50～65岁42例(42.9%)，66～83岁56例(57.1%)。疾病：冠心病53例(57.2%)，高心病24例(24.4%)，肺心病11例(11.2%)，风心病8例(8.2%)，扩张性心肌病2例(2.0%)。? 　　心力衰竭的定义：指在各种致病因素的作用下，心脏的收缩和(或)舒张功能发生障碍，心输出量下降，从???使组织、器官血液灌注不足，同时伴有肺?环和(或)体循环淤血表现的临床综合征。? 　　诊断心衰的依据：典型症状是呼吸困难、乏力、水肿；客观依据如：心腔扩大、心脏杂音、UCG异常、BNP升高等。? 　　按部位进行心衰分类后的临床表现：①左心衰：活动后胸闷、气喘、咳嗽、咳白色或粉红色泡沫痰，严重时不能平卧。端坐呼吸，夜间阵发性呼吸困难，大汗淋漓，心前区疼痛等。部分患者脉搏加快，血压升高(高心病时明显)，肺底或全肺湿?音，心律不齐或心律失常，舒张期奔马律或收缩期杂音。X线表现阶段A、B可无异常，阶段C、