Interpretation of 2021 ESC guidelines for the diagnosis and treatment of acute heart failure
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关键词:
- 急性心力衰竭 /
- 急性失代偿性心力衰竭 /
- 指南解读
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Key words:
- acute heart failure /
- acute decompensated heart failure /
- interpretation
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表 1 AHF的相关临床表现
ADHF 急性肺水肿 单纯右心衰竭 心源性休克 主要机制 左心室功能障碍
肾脏水钠潴留后负荷增加和(或)显著左室舒张功能障碍/心脏瓣膜病 右心室功能障碍和(或)毛细血管前肺动脉高压 严重心功能不全 主要原因 液体积聚，心室内压力增高 液体再分布至肺，急性呼吸衰竭 中心静脉压升高，常伴有全身灌注不足 全身灌注不足 发病 逐渐(数天) 迅速(数小时) 逐渐或迅速 逐渐或迅速 主要血流动力学异常 左室舒张末压和肺毛细血管楔压增加
心排量正常或降低
收缩压正常或降低左室舒张末压和肺毛细血管楔压增加
心排量正常
收缩压正常或升高右心室舒张末压增加
心排量降低
收缩压降低左室舒张末压和肺毛细血管楔压增加
心排量降低
收缩压降低临床表现 湿暖或湿冷 湿暖 湿冷 湿冷 主要治疗 利尿剂
正性肌力药物/升压药(如有外周低灌注/低血压)
必要时短期机械循环支持或肾脏替代治疗利尿剂
血管扩张剂利尿剂治疗外周淤血
正性肌力药物/升压药(如有外周低灌注/低血压)
必要时短期机械循环支持或肾脏替代治疗正性肌力药物/升压药
短期机械循环支持
肾脏替代治疗
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