课件：老年人慢性心力衰竭的处置及社区管理.ppt

* 选择性血管加压素（AVP）Ⅱ型受体（简称V2受体）拮抗剂 （托伐普坦） * * 心衰治疗流程 确定慢性收缩性心衰的诊断 （左心室心腔增大，LVEF≤40%） 去除或缓解基本病因和诱因 （瓣膜性心脏病对手术治疗作出评定） （冠心病、心绞痛或有存活心肌对血运重建作出评定） 判断液体潴留情况 有液体潴留的症状和体征 无液体潴留的症状和体征 利尿剂 ACEI (应用至病情控制长期维持) （NYHA心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级） Β-受体阻滞剂 地高辛——控制症状 （主要为NYA 心功能Ⅱ、Ⅲ 级） （NYHA心功能Ⅱ、Ⅲ、Ⅳ级） Condition Prevalence in HF Potential Consequences Assessment Technique Renal Dysfunction 16%: GFR 30 ml/min 40%: GFR 30 - 59 ml/min Worsens symptoms, prognosis; exacerbated by diuretics, ACE inhibitors, and ARBs. Cockroft-Gault Formula MDRD Formula Chronic Lung Disease 20% to 32% Worsens symptoms, prognosis; exacerbates right heart function Pulmonary Function Tests Dementia/ Delirium Dementia: 8.5% Delirium: ~50% of hospitalized Worsens non-adherence Mini-Mental State Examination Mini-Cog; CAM (Confusion Assessment Methodology) Diabetes 30-50% Worsens prognosis; risk of vascular disease, dementia, CKD, and anemia Blood glucose; Glycosylated hemoglobin Depression 8% Worsens prognosis; exacerbates symptoms Geriatric Depression Scale Falls, Mobility 30-50% Exacerbated by diuretics and vasodilators, impairs mobility, and interferes with follow-up Timed Get up and Go; Tinetti Gait and Balance Scale; Berg Balance Scale Postural Hypotension Postural: 10-30% Postprandial: 10-20% Worsened by diuretics, vasodilators Orthostatic/postprandial blood pressure measurements; Anemia Inpatient: 70% Outpatient: 10-20% Worsens symptoms, increases risk of hospitalization Complete blood cell count Urinary Incontinence Women 35% Men 22% Aggravated by medical therapy (diuretics, ACE cough) Bladder diary Sensory Impairments 24%: Ocular disorders Worsens non-adherence, increases medication errors Hearing loss screener; Snellen eye chart Frailty 30-50% Worsens sympto