ESC急慢性心衰诊治指南要点.ppt

20190109 医疗课件医生医院治疗疾病我人有的和主产不为这工要在地一上是中国经以发了民同 优秀幻灯片与大家分享 优秀幻灯片与大家分享 * 此处只提要点，相关内容会在后面的AHF部分详述。 * 提出了一种新的、根据是否存在充血/低灌注的急性心衰诊断和治疗流程。 此处只提要点，相关内容会在后面的AHF部分详述。 * 心衰是一种危及生命的临床综合征，对全球6000万人口造成影响。此次指南更新为心衰治疗带来突破性的新选择，进一步改善心衰患者的预后与生活质量。 * 指南原文： For patients presenting with symptoms or signs for the first time,non-urgently in primary care or in a hospital outpatient clinic, the probability of HF should first be evaluated based on the patient’s prior clinical history [e.g. coronary artery disease(CAD), arterial hypertension, diuretic use], presenting symptoms(e.g. orthopnoea), physical examination (e.g. bilateral oedema, increased jugular venous pressure, displaced apical beat) and resting ECG. If all elements are normal, HF is highly unlikely and other diagnoses need to be considered. If at least one element is abnormal,plasma NPs should be measured, if available, to identify those who need echocardiography (an echocardiogram is indicated if the NP level is above the exclusion threshold or if circulating NP levels cannot be assessed) * 1.依据识别急性病因早期启动适当治疗（an early initiation of appropriate therapy）的概念，遵循急性冠脉综合征(ACS)确立的“最佳治疗时间”（time to therapy）方法。 2.基于是否存在充血和/或低灌注的临床特征，将AHF分为四类，并据此确定AHF诊疗的新流程 3.对于没有症状性低血压的急性心衰患者SBP＞90mmHg推荐应用血管扩张剂减轻症状。（2012版SBP＞110mmHg ） * 指南原文： 1 Clinical classification can be based on bedside physical examination in order to detect the presence of clinical symptoms/signs of congestion(‘wet’ vs. ‘dry’ if present vs. absent) and/or peripheral hypoperfusion(‘cold’ vs. ‘warm’ if present vs. absent) 2 The combination of these options identifies four groups: warm and wet (well perfused and congested) —most commonly present; cold and wet (hypoperfused and congested); cold and dry (hypoperfused without congestion); and warm and dry (compensated, well perfused without congestion). 3 This classification may be helpful to guide therapy in the initial phase and carries prognostic information * 充血表现：肺充血，端坐呼吸，外周水肿，颈静脉扩张，充血性肝肿大，肠道淤血，腹水，肝颈静脉回流等 低灌注表现：四肢冷汗，少尿，精神混