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1、福建医科大学附属第一医院 晋学庆 重症心衰治疗指南与临床实践 指南与临床实践的关系 Evidence-Based Medicine Problem-Based Medicine 心脏重症 特点 1.心衰 合并多器官功能衰竭，心、肺、肾 2.心衰 心脏受损严重为突出表现，大面积心梗 ， 心脏手术，重症心肌炎 3.心衰 特殊原因，少见，特别是一些新的药品 ， 器械 Your heart is an amazing powerhouse that pumps and circulates 5 or 6 gallons of blood each minute through your entire
2、body. Understanding how the heart works To understand heart disease, you must first know how the heart works. The heart is like any other muscle, requiring blood to supply oxygen and nutrients for it to function. It beats about 100,000 times a day, pumping blood through your circulatory system. The
3、cycle of pumping blood throughout your body carries fresh oxygen to your lungs and nutrients to your bodys tissues. Blood also takes waste, such as carbon dioxide, away from your tissues,. Without this process, we could not live. Heart disease: the number-one killer Heart disease affects about 14 mi
4、llion men and women in the United States, and it has a high mortality rate One of the most devastating consequences of heart disease can be sudden cardiac arrest. Blockage of the coronary arteries by plaque may cause a heart attack (myocardial infarction) or a fatal rhythm disturbance (sudden cardia
5、c arrest). Sudden cardiac death - a fatal consequence of heart disease Everyones experience with heart disease is different. Some people experience shortness of breath or chest pain and make it to the hospital in time to be treated. Others are not as lucky. For some people, sudden cardiac arrest can
6、 be the first symptom they experience, and it is often deadly unless treated immediately. Besides chest pain (angina) and shortness of breath, some other common symptoms of heart disease include jaw pain, back pain, and heart palpitations. What are common symptoms of heart disease? Symptoms of heart
7、 disease usually occur during exercise or activity. Thats because the heart experiences increased demand for nutrients and oxygen that cannot be met because the coronary arteries are blocked. Other symptoms of heart disease include chest pain (angina), shortness of breath, jaw pain, and back pain, e
8、specially on the left side. Doctors use a variety of tests to detect heart disease. One common test is the electrocardiogram (ECG or EKG). What is an electrocardiogram (EKG)? A healthy heart works as an electrical pump and needs a strong blood supply to conduct electricity. People with heart disease
9、, however, have a weak blood supply, so their hearts conduct electricity poorly. An electrocardiogram (EKG) is a noninvasive test that measures the electrical activity of the heart. An EKG takes approximately five minutes and is painless. Many other heart conditions can be diagnosed with an EKG, for
10、 example abnormal heart rhythms, evidence of prior heart attack, evidence of an evolving heart attack, unstable angina, congenital heart abnormalities, evidence of abnormal blood electrolytes, and evidence of inflammation of the heart (myocarditis, pericarditis). Sometimes, if an electrocardiogram c
11、omes back normal, doctors will use stress tests to detect heart disease. Another test option is echocardiography, which uses sound waves to generate images of the heart. Computerized tomography (CT) scans are used to show that heart disease is not present and that the coronary arteries are normal. C
12、oronary angiography via cardiac catheterization is considered the gold standard of heart disease tests. Heart disease treatment is different for everyone. For some patients with heart disease, medications may be necessary. When medications arent enough, sometimes invasive procedures are used to help
13、 treat heart disease. Heart disease is a highly preventable and reversible disease. A healthy diet is a major factor in controlling heart disease. Other lifestyle changes that can be made to help prevent heart disease include drinking alcohol in moderation and quitting smoking. Exercise, controlling
14、 high blood pressure and diabetes, and taking daily aspirin are more ways to reduce your chances of developing heart disease. 心脏重症病房的治疗手段进展 3.1 呼吸机辅助通气 3.2 肾脏替代治疗 3.3 主动脉内球囊反搏术(IABP)和左心辅助装置 (LVAD) 3.4 ECMO（体外膜肺氧合） 在国外，特别是欧美发达国家，心脏重症医学的诞 生起源于心肺复苏术的开始，要早于真正的综合性 ICU的建立。从1962年开始，Melter He和Day分别 创立冠心病监护病
15、房，从此心脏重症医学在世界发 达国家特别是欧美地区迅速发展，以CCU或CICU 为代表的心脏重症监护病房已经成为心脏医疗中心 中不可缺少的组成部分，代表了一家中心的心脏医 疗水平，救治水平和管理水平，更与医疗单位或中 心的现代化水平挂钩 定义 心力衰竭是由于任何心脏结构或功能异常导致心室 充盈或射血功能受损的一组临床综合征，其主要临 床表现为呼吸困难和乏力（活动耐量受限），以及 液体潴留（肺淤血和外周水肿）。心衰为各种心脏 疾病的眼中和终末阶段，发病率高，是当今最重要 的心血管病之一。 心衰发展分为4个阶段 根据心衰发生发展的过程，从心衰的危险因素进展成结 构性心脏病，出现心衰症状，直至难治性终末期心衰, 可分成4个阶段。 前心衰(A) 前临床心衰(B) 临床心衰(C) 难治性终末期心衰(D) 这4个阶段不同于纽约心脏协会(NYHA)的心功能分级。 心衰阶段的划分正是体现了重在预防的概念，其中预防 患者从阶段A进展至阶段B，即防止发生结构性心脏病 ，以及预防从阶段B进展至阶段C,以至于进展到D阶段 。 依据左室射血分数(LVEF), 心衰可分为 LVEF降低的心衰(heart failure reduced left ventricular ejection fr
