老年人心衰医学课件.pptVIP

心脏再同步化治疗（CRT或者CRT-D ） ICD 心脏移植或者人工心脏 心力衰竭非药物治疗 * 心脏再同步化治疗 * 5 年生存率， 70%—80% 供体来源 排异反应 心脏移植 * 水凝胶治疗 * 护理要点 心理护理 一般护理：体位 活动与休息 饮食与饮水 吸氧 药物治疗。 记录24小时出入量； 加强皮肤及口腔的护理； 保持大便通畅：用力大便可使腹内压增加→心脏负担加重→心肌缺氧加重；又由于迷走神经张力过高，反射性引起心律失常→危及生命； 控制静脉补液速度：20~30滴/分； 密切观察病情变化：a、生命体征、紫绀及肺内体征变化；b、洋地黄类药物的毒性反应。 * 用药护理 硝普钠: 小动脉、静脉扩张剂，降低左右室充盈压及前后负荷，增加左心排出量，降低心肌耗氧 。由小剂量开始，20 g /min 起，可逐步增加剂量，有效剂量范围大多在 50 ～ 150 g /min，超过72h 有氰中毒，24h 更换1 次液体，避光应用，多用于高血压危象 酚妥拉明:α 受体阻断剂，扩张小动静脉，初始量0. 1 g /min，一般有效剂量 0. 3 g /min，有时根据需要可调至2 g /min * 2018 正确的解读超声心动图报告，了解超声基本知识是前提。目前在临床最精彩使用的超声心动图检查方法主要有以下几个方面 In late 2001, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new classification system to be used in addition to NYHA class for diagnosing HF. This system rates patients from stages A to D. Stage A patients are at high risk for developing HF but show no structural or functional abnormalities and have never shown signs or symptoms of HF. (Risk factors for HF include DM, Hypercholesterolemia, HTN, and family history of a cardiomyopathy.) Stage B patients present with structural heart disease but have never shown signs or symptoms of HF.1 Structural heart disease is shown usually via an Echo or some other means of diagnostic testing. Patients in Stage C have symptoms of HF currently or have had symptoms associated with underlying structural heart disease. Stage D patients have advanced structural heart disease and pronounced symptoms of HF. These patients often require special interventions. As classified by the ACC/AHA guidelines, patients in stages C and D have CHF.1 It is important to point out that a patient can go from Stage A to D, but the stages cannot be reversed! Unlike NYHA class these categories don’t go up and down just down. The next slide shows the NYHA compared to the new stages. Reference: Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart fai