The definition of heart Shuai:
Enough have second thoughts amount of blood, because of heart before, behind carry to increase the pump blood that Gao or myocardial pathological changes cause function not whole, can’t satisfy a machine body a metabolism of demand or can’t have second thoughts blood to fight in time, the nerve hormone excessively activates, with the result that organization energy supply shortage, and heart, blood vessel, myocardial cell, gene, member, secrete beside, from secrete to adjust to control an abnormality, with the result that blood dynamics abnormality but cause of comprehensive advertise for.
(A)General treatment
1, take a rest with food:Suffer from son to all need to lie a bed rest, to fidgety and uneasy should use a tranquilizer, like benzene Ba Bi3 Tuo3, ground west Pan(stabilize)…etc., food should much eat to contain abundant the vitamin easily digest with low salt food, avoid eat and drink too much at one meal, serious heart Shuai should limit water to go into quantity, keep facile defecation.
2, oxygen:The general heart Shuai is a particularly serious heart Shuai to have supply of pulmonary edema the oxygen has much of a necessity, but suffer from son,such as aorta bow, to leave to break towards depending on liberal artery pipe but existing first secret concern, the aorta turn a , aorta petal to shut lock etc., supply the oxygen can make the blood oxygen increase Gao but urge artery pipe a close but endanger life.
3, body:Serious heart Shuai’s suffering from son often can’t be even to lie, old son commendable half seat, the year little infant can start to embrace, make the bottom of the legs hang, decrease vein reflux.
4, maintenance water electricity balance:Heart Shuai take a meal bad, easily erupt kidney function not whole, as a result often easily water electricity disequalibrium happen, easy occurrence sour poisoned, over a long period of time low salt food, use diuretic alter low potassium, low sodium, have to discover and rectify in time.
(Two)Cause of disease and merger disease cure
The cause of disease treatment is very important to heart Shuai and separate defection and damage such as the huge room partition defection and damage, thick short artery pipe, building room, first the secret concern merger pneumonia heart Shuai.Medicine’s cure often doesn’t easily control heart Shuai.Tiny because of getting involved treatment and heart in recent years create open of surgical operation an exhibition to make first secret concern a treatment wound is small, surgical operation time be short, curative effect good.
The heart Shuai suffers from the son annexable heart Lyu mess, heart source shock, water electrolyte mess all the beard rectifies in time.
(Three)The medicine cure
1, the medicine of the impatient heart Shuai cure
1)positive sex muscle dint medicine
⑴ Digitalis product:
The digitalis passes to repress the heart Shuai myocardial cell membrane Na+/K+ATP Mao, make sodium level inside the myocardial cell increase Gao, promote Na+/Ca+exchange, make Ca inside the cell+the level increase Gao, exertive positive sex muscle dint function.make heart output quantity increment, the ventricles comfortable piece last phase pressure descend, wet quantity increment, improve the heart exportation quantity shortage and vein blood clot thus, vice- hand over feeling to stream into nerve, Na in the meantime+/K+the ATP Mao be repress and make the bottom of the central nervous system reach of the excitement die down and make the heart rate reduce slowly.
The adrenaline of ⑵β is subjected to the body excited:
This kind of medicine is a positive sex muscle dint medicine of the wreath phosphoric acid gland Mao(cAMP) dependence, this medicine passes cAMP level inside the exaltation cell but the increment myocardial constringency dint, and and have outside week blood vessel to extend a function, the in common use product has a dopamine(dopamine, intropin), many Ba Fen Ding An.(dobutamine, dobutrex)The dopamine in common use measures for the 2-10 mcgs/kg/min, add to the 15 mcgs/kg/min(the biggest measure a 40 mcgs/kg/min) an importation(shouldn’t input in the meantime with alkaline liquid) from the vein pump when it’s necessary, many Ba Fen Ding the An measure for the 2-20 mcgs/kg/min, should as far as possible adopt least significant quantity, in order to prevent energy consume excessive or induct heart Lyu mess.BE narrow(IHSS) to deliver sex fatty and thick sex aorta a petal a bottom at first, the building Zhan, building rush toward to suffer from son taboo an usage.The dopamine shows Zhao towards suggesting high blood pressure effect compare, but easily causes heart Lyu mess and have another Ba Fen Ding An to suggest high blood pressure effect worse, but less cause heart Lyu mess.
⑶ Phosphoric acid two fat Mao depressant:
This kind of medicine belongs to a positive sex muscle dint medicine of the cAMP dependence, repress phosphoric acid two decrease cAMP inside the cell of the fat Mao F-Ⅱ (PDEF-Ⅱ )s to decline a solution to make the cAMP level increase, but raise myocardial constringency dint and and have an outside week an afferent and comfortable piece a function.Short date application have good blood dynamics an effect, crock up effect to show Zhao to the heart attack postoperative mental exertion, applied not only can’t improve a clinical circumstance over a long period of time, anti- can increase ill rate.
Ammonia dint agriculture:
Head be quiet to note a 0.75~1 mgs/kg, can repeat one more when it’s necessary, then the 5~10 mcgs/kg/min keep on quiet drop and the side effect reduces for the heart Lyu mess, blood platelets.
Rice dint agriculture:
Efficacy of medicine is ammonia dint agriculture of 1000%, quiet note first time quantity is every time 50 mcgs/kg, give in 10 minutes, hereafter keep on a vein intravenous drop, 0.25~0.5 mcgs/kg/min.
⑷ Heart first Anne(the wreath phosphoric acid gland Mao Pu AN An MCA):
BE the derivatives of the wreath phosphoric acid gland Mao that the artificial synthesize, can raise the myocardial Ca inside the cell 2+ densities, improve the myocardial pump blood function, make row strenuous effort quantity to increase, extend an outside week blood vessel, carry after easing heart, lower a myocardial oxygen consumption, measures for the 2~4 mgs/kg, dissolve at the glucose 10 mls, slow-moving quiet push, totally use 5~7 days at a time everyday.Reach high peak for 1~2 hours since the effect for 10~20 minutes after inject, disappear for 6~8 hours.
⑸ Left west Meng Dan(Lerosimendan):
BE a calcium to increase a quick, cure heart after operation with extend the heart Shuai of sex myocardial disease, short-term usage have good curative effect.Carry the quantity intravenous injection 12 mgs/kg, hereafter 0.1~0.2 mcgs/kg/min, totally use 24 hours, still need further contrast the curative effect of analytical and other positive sex muscle dint medicine.
2)diuretic
The in common use diuretic have:
① Function Henry(Henle) climb of diuretic such as the rice of Mao Mao(soon wet furosemide) increment urine the sodium excretion can reach a sodium to once filter burden of 20%~50%, and can strengthen Zhu to stay aqueous clearance, in addition to the kidney function’s severity is damaged(the muscle Mao clearance rate<5 μ l/ mins) outside and all can keep an its benefit urine function.
② Function far song small tube skin quality dilution the Mao Mao of the segment be like the hydrogen chlorine Mao Mao(double hydrogen gram urine Mao hydrochlorothiazide), the increment wet sodium excretion of the score once filtered burden for the sodium of 5%~10%.When degree injure(the muscle Mao clearance rate<30 μ l/ mins) in the kidney function lose efficacy.
The ③ function is small to take care of a distant place at the far song like fat inside the Luo.(Anne’s body comfortable spironolactone)Discover still in recent years to have the anti- Quan the solid Tong function, as a result to the treatment heart Shuai for apply.
The bad function of diuretic have:
① Water electrolyte throws to lose, result in to dehydrate with low potassium, low sodium, low magnesium and even induct heart Lyu mess.
The ② nerve hormone excessively activates, especially kidney vegetable-afferent strain vegetable-the Quan solid Tong system(RAAS), so should use ACEI in the meantime.
The ③ low blood pressure and the nitrogen quality blood disease.
3)the blood vessel extend
The blood vessel extends a treatment heart Shuai mechanism to have:
The ① extends small artery, carry after lowering heart and increase heart to output quantity.
The ② extends vein, reduce to have second thoughts amount of blood and carried before lower.
③ Increment ventricles comfortable Zhang Qi2 adjust sex.
The ④ lowers heart to in front and back carry, the increment ventricles conformance, reduce a slow heart rate thus, lower myocardial oxygen consumption and energy depletion.
Mainly used for ventricles Chong Ying to press to increase Gao Zhe3, can make heart a row blood quantity increment, but press to lower to the left room Chong Ying or normal should not use.
Choosing to extend with the blood vessel should according to suffer from a son blood dynamics variety but settle
① To lung blood clot severity, the lung hair thin afferent Qian presses obvious increment(>32 mmHgs), heart row the blood quantity be light to medium the degree descend, proper choose to use to extend a vein medicine.
The ② obviously lowers to the heart row blood quantity, whole body afferent resistance increment, but the lung hair thin afferent Qian press while normally or slightly going up, proper choose to use to extend a small artery medicine.
The ③ heart row blood quantity obviously lowers, whole body afferent resistance increment, when the lung hair thin afferent Qian presses to go up, proper choose to extend small artery and vein medicine with the well balanced.
Above-mentioned principle have to combine to suffer from the son concrete condition but settle.
4)the myocardial energy’s metabolism endow with to live a medicine
In common usely have currently
① Fructose two phosphoric acid sodium(FDP)s:
The outside source FDP can contribute to repairing sugar Xiao a solution and increase phosphoric acid creatine and ATP content, in addition the FDP pass to repress a neutral grain cell oxygen a free radicals born, ease heart Shuai thus with the result that organization hurt but have function of protect the myocardial.
The FDP dosage is a 100-200 mgs/kg/d, everyday an intravenous injection.The vein speed should be about the 10 mls/min(75 mgs/ml).
The afferent stimulative is more big when the FDP is quiet to note, thin to little infant’s vein, often can cause to suffer from son to cry and scream to aggravate heart burden because of ache, so can also use to take orally a product.
The ② assists the Mao Q10:
Can promote to oxidize phosphoric acid to turn reaction, there is anti- oxygenation, the integrity of protection and instauration living creature result, the Jie anti- Quan solid Tong stays water, sodium Zhu and be applicable to the treatment toward the heart Shuai.In order to take orally the 10 mgs in every time, quantity everyday 1-2 times, the muscle note or quiet note everyday 5-10 mgs.
Take effect because of assisting the Mao Q10 more slow-moving, past and unwell used for impatient heart Shuai.
③ Phosphoric acid creatine(CP):
BE 1 kind to efficiently provide ability material, the outside source CP can maintain the phosphoric acid level of myocardial cell, stable cell membrane, the protection myocardial cell doesn’t need to be subjected to an oxygen free radicals over oxidize damage.
Baby’s kid’s 1 g/d, old son 2 gs/d.
5)other medicine
The ①γ brain sodium Mao(γ BNP):
Inside the west benefit others(resiritide Natrecor) to in suffer from the son improvement blood dynamics and benefit to wet a function to the heavy degree heart Shuai quick and safety, the quantity measures a 2 mgs/kg for the burden, the vein slowly pushes time a minute above(can also need not burden measure), hereafter 0.005-0.03 mgs/kg/min.The side effect has low blood pressure, heart Lyu mess, disgusted.The domestic still little applied report way.
The bad cause of death son of the ② anti- tumor(TNF)
Medicine such as depend on that west Pu(etanercept), the English benefit Xi single anti-(infliximab).Still at the clinical verification stage.
Skin vegetable(ET) inside the ③ blood vessel is subjected to the body Jie anti-:
The non- selectivity ET is pull by the body Jie anti-’s boon to living Tan(enlacentan) and the wave livings Tan(bosentan);The selectivity ET is reach by the body Jie anti- the Lu living Tan(dalusentan) still at clinical try out a stage.
Mao Mao(NEP) inside the ④ neuter gender/afferent strain vegetable(ACE) dual depressant:
The NEP declines the solution benefit sodium Mao(ANP and BNP) and also participate the blood vessel nervous plain Ⅱ and decline of other constringencies afferent factors solution in the meantime.The NEP depressant can go up blood plasma ANP and BNP level, dynamics and clinical symptom of the improvement blood.NEP/ACE dual depressant Ao Ma3 Qu pull(omapatrilat) just at clinical try out a stage.
The ⑤ anti- adrenaline medicine:
The promise Man rice road(nolominole, CHF-1025) is the dopamine D2 and α 2 adrenalines be subjected to the body Jie anti-, is used for the clinical trial stage which cures heart Shuai.
2, the medicine of the chronic heart Shuai cure
Chronic mental exertion’s crocking up(CHF) the pathologic foundation of occurrence development is a myocardial to remould(cardiac remodeling) and have after the beginning start of myocardial hurt variety of inside activate of the source nerve, endocrine and the cell factor, include sympathetic nerves system(SNS) and kidney vegetable-afferent strain vegetable-the Quan solid Tong system(RAAS) excessively activates with white lie vegetable 1 and 6, inside the skin vegetable and the tumor bad cause of death son(TNF-α 1) etc. the level increase Gao, the latter helps the myocardial to remould further, two interact as both cause and effect, become the vicious cycle of heart Shuai, after prepare depravation.
1)the nerve endocrine Jie anti-
(1)The afferent strain vegetable converts Mao depressant(ACEI):Stopped RAAS and repress slowly a function of arouse the Mao decomposition, converse a myocardial to remould thus and the heart in front and back carry, improve myocardial function and have become currently anti- CHF the sill of the treatment.
The ① card gives Pu benefit(captopril):Short effect product, the beginning starts to measure a 0.2 mgs/kg/d, pass to increase once every week, increase a 0.3 mgs/kg/d each time, biggest bear is measured a 5 mgs/kg/d, the q 8 hs take orally.Continuously time more than at least 6 months, average 2 years, go to heart to contract close normal.
② Benzene that Pu benefit(benazepril):Long effect product, the beginning starts to measure a 0.1 mgs/kg/d, once take orally everyday, pass to increase once every week, increase a 0.1 mgs/kg/d each time, biggest bear is measured a 0.3 mgs/kg/d, maintain time together up.
The ③ depends on that Pu benefit(enalapril):Long effect product, the beginning starts to measure a 0.05 mgs/kg/d, once take orally everyday, pass to increase once every week, increase a 0.05 mgs/kg/d each time, biggest bear is measured a 0.1 mgs/kg/d, maintain time together up.
(2) The blood vessel nervous plain II is subjected to the body Jie anti-(ARB):
Can stop the AngII from different path(include ACE and the path of Mi Mao), don’t to the ACEI used for a sufferer to bear to be subjected to or ineffective, like Luo sand Tan(losartan), Xie sand Tan(valsartan), the effect is similar to ACEI.
(3)β -Be subjected to the body Zu Zhi:
The SNS excessively activate(because of high density NE to the myocardial poisonous sex function) while can stop heart Shuai, can repress a myocardial fatty and thick and cell Diao the Wu should arouse reaction with oxidize, improve the biology activity of the myocardial cell, strengthen heart function thus and have already listed as a glimmer of medicine of anti- CHF currently.
In common use medicine:Give Luo Er such as the United States, card Wei ground Luo, peso Luo Er…etc..
① The United States gives Luo Er:(metoprolol, also beautiful and over-sensitive Anne or doubly his Luo gram)
For selectivity β 1-be subjected to the body Zu Zhi, the beginning starts to measure for the 0.2~0.5 mgs/kg/d, pass to increase once every week, increase a 0.5 mgs/kg/d each time, average biggest bear is measured a 2 mgs/kg/d, separately 2 times take orally, keep on time for more than at least 6 months, average 2 years, go to heart to contract close normal.
The ② card Wei ground Luo(carvedilol):
For non- selectivity β -be subjected to the body Zu Zhi, also the α be subjected to the body Zu Zhi function, past and have already expanded an afferent function, can lower lung Xie to press.The beginning starts to measure for the 0.1 gs/kg/d, divide to 2 times take orally, pass to increase once every week, the time increases a 0.1 mgs/kg/d, biggest bear is measured a 0.3~0.8 mgs/kg/d, separately 2 times take orally, maintain time together up.
(4) The Quan solid anti- of Tong Jie:
Can repress a kidney vegetable further-the function of the blood vessel nervous plain system, can stop myocardial and quality to remould, moreover can also stop the effect of the Quan solid Tong(ALD), have already confirm to exist ALD to be subjected to a body in the human body myocardial, be applicable to the heart function III-IV class a sufferer.
In common use medicine: Ester(Anne’s body comfortable) inside the Luo, measures a 2~4 mgs/kg/d and divide to 2 times take orally.
(5)Strong heart Mao:
The chronic heart Shuai’s stability’s period normal regulations’ application takes orally a ground of Gao Xin maintenance quantity a method, then use saturated quantity of 1/4~1/5 quantity, divide 2.
Over a long period of time unite an application should unite an application with the nerve endocrine Jie anti-.
In addition to positive sex muscle dint function, the digitalis has already repressed a pair to hand over feeling to stream into neurotic Na as well+/K+the function of ATP Mao, raise the sensitivity that aorta bow and carotid artery Dou pressure feel a machine, repress to stream into impulse, so have already repressed the function that the sympathetic nerves excessively activates, and didn’t bear a medicine.
2)the blood vessel extend:
(1)The afferent strain vegetable converts Mao depressant(ACEI):
Chronic heart Shuai often rules application ACEI, because of in addition to the function of Jie anti- AngII, it have already extended an afferent function as well, past generally need not add again to extend another.If the one who have obvious lung extravasated blood, can add to use vein blood vessel to extend, such as nitric acid different mountain pear Chun(eliminate heartache), measures a 0.4~0.6 mgs/kg/d and separately 2 times take orally.
(2) The prostaglandin E1(PGE1):
Be applicable to first the treatment of the secret concern lung artery high pressure, also be applicable to the aorta pathological changes(such as aorta Suo narrow etc.) merger heart the new born of the Shuai and baby kid, can the vein drop note the mgs/kgs/mins of the prostaglandin E10.1 and counteract a dopamine<the artery pipe for 7 to note, delay a close and increase Suo a narrow and distant rtery blood quantity and ease to infuse to note burden inside lung.
3)diuretic:
The chronic heart Shuai has water sodium Zhu to stay and should add to use diuretic, but use over a long period of time and have already activated a nerve endocrine function, so be applicable to dropsy add to use, swollen eliminate behind namely withdraw, the amount of’s method of using is together ex-.
Chronic contractility heart Shuai different heart function the medicine of the ratings choose to advertise for with
(According to 2001 NYHA child heart function ratings standard)
The NYHA heart function II class:ACEI, β -be subjected to a body Zu Zhi, ground Gao Xin
The NYHA heart function III class:ACEI, β -be subjected to a body Zu Zhi, ground Gao
Xin, a Chinese family name, the diuretic one who have dropsy)
The NYHA heart function IV class:ACEI, β -be subjected to a body Zu Zhi, ground Gao
Xin, a Chinese family name, Quan solid anti- of Tong Jie, after cure
The heart Shuai has amendment, heart function’s improvement to reach III
The class can carefully use β -be subjected to the body Zu Zhi.
(Four)The non- medicine cure
(1)The ventricles assistance equip(VAD):
BE in recent years to study of a lot of, develop very quick heart Shuai assistance therapy.Mainly used for heart Shuai a last phase, the medicine have no command over of the heart Shuai be a heart transplantation to wait for a period treatment method.The VAD is 1 several hundred grams of heavy devices, transplant a body, is led run off artery blood by the left building and pass to equip chase blood pump go into aorta, fight amount of blood by increment, improve a blood dynamics abnormality, ease heart Shuai symptom.Price’s ising more expensive is it important weakness.
(2)Ball bag inside the aorta is anti- to fight(IABP):
Will an anti- fight a ball bag to transplant aorta, push blood to flow toward the aorta distant place with increase heart to fight amount of blood, carry after easing heart, mainly used for heart after operation the short-term application of heart Shuai, to heart after operation heart function of the instauration have better effect.
(3)The heart reduces to permit surgical operation:
Heavy to the ventricles of heart attack Gou severity, cut off already have no function or few function of already the fiber turn a myocardial, with improvement the myocardial conformance, strengthen myocardial constringency and comfortable piece function, ease symptom, the improvement includes after prepare certain curative effect.
(4)Film lung(ECMO):
Mainly is used for heart after operation or myocardial disease, myocarditis…etc. with the result that heart Shuai or respiratory failure, the one who estimate to is compare in a short time to recover, pass film lung to improve to suffer from son anoxia condition.
(5)Heart transplantation:
To various heart attack with the result that heart Shuai, all can do heart transplantation, improve life quality when the medicine have no command over, extension life.The treatment effect of the child heart transplantation shows a Zhao exaltation in recent years, the 5 years’ livability is more than 80%, and the 10 years’ livability is more than 60%.Provide a body a difficulty and line up a difference reaction and expenses expensive is it important weakness.
(Five)Heart Shuai a few special circumstances handle
(1)The heart Shuai merge heart Lyu mess:
The relation of of heart Shuai and heart Lyu mess is more complicated, can be caused heart Shuai and heart Lyu mess in the meantime by a cause of disease(like myocarditis, myocardial disease), can be also caused the heart Lyu mess or heart Lyu mess by heart Shuai to cause heart Shuai.Heart Shuai abrupt death sufferer the half the number died in ventricles quiver(call room Zhan as follows), room to once move soon(as follows call room soon), the Dou once moved slowly(as follows call Dou slowly), Ⅲ degree building room conduct Zu Zhi and electricity machine become disjointed.
Tally up heart Shuai combine heart Lyu mess of medicine treatment principle is:
The ① doesn’t keep on sex and have no symptom room or the mess need not anti- heart Lyu of the room top heart Lyu to disorder a medicine.
The ② keeps on sex room soon, room Zhan, the top of the room soon when the ventricles rate speed, should use anti- heart Lyu disorder medicine.
The ③Ⅰ and Ⅱ anti- heart Lyu disorder a medicine to die down heart function, need not at the heart Shuai combine heart Lyu mess.
The ④Ⅲ anti- heart Lyu disorders An iodine within medicine, the Tong doesn’t influence heart function and recommend usage at the heart Shuai combine heart Lyu mess, the An iodine Tong settle towards preventing heart Shuai from die abruptly effect be not willing to, don’t recommend an usage.
The ⑤ looks for reason,such as blood pressure, to lead low, the myocardial lack blood, low potassium, low magnesium etc. to rectify in time.
(2)Impatient pulmonary edema:
The impatient and left heart crocks up to have another to take pulmonary edema as to mainly express and the condition is urgent.Should quickly adopt effectively, correct treatment measure.Concrete method is as follows:
⑴ Body:Suffer from the son takes half seat or seat, move to ease a dyspnea through the bottom of the Ge muscle, and reduce a vein reflux, carry before easing heart.
The ⑵ absorbs oxygen:General adoption nose pipe or mask method, have obvious rtery carbon dioxide a cent to press(PaCO2) to go up and oxygen cent press(PaO2) to descend can use machine breath, in common use and intermittent is press breath(IPPB) or breathe out an end is press to ventilate(PEEP).Absorb to join alcohol and organic Huo to eliminate a bubble in the liquid of liquefaction bottle that the oxygen pass, can make the foam surface tension lower but break, improve to ventilate function, there is minority suffering from son to the alcohol allergy, inhale after the above-mentioned air the fidgety shouldn’t then use.
The ⑶ town is quiet:
The heart Shuai companion pulmonary edema suffers from son often because of anoxia dismay but fidgety, aggravate heart burden, should use a tranquilizer.(such as stabilize, Lu rice sodium)
Can use morphine to the fidgety serious.The morphine not only can ease fidgety, and can extend vein and carried before ease.Measures for the 0.1~0.2 mgs/kg each time, quiet note or the muscle note.To new born or haven’t whole breath function taboo an usage.
The ⑷ blood vessel extends:
Can ease heart to in front and back carry, in order to cure impatient pulmonary edema important measure, the medicine chooses to use to see the medicine treatment of the impatient heart Shuai with method of using.
⑸ Diuretic:
Should use strong dint fast diuretic such as soon wet, cloth beautiful his Ni etc., often after use medicine 1~2 hour namely the occurrence show Zhao curative effect, the medicine chooses to use with the method of using see the medicine treatment of impatient heart Shuai.
⑹ Digitalis product:
Should quickly calm down to note a fast digitalis product to see the medicine treatment of impatient heart Shuai such as ground the orchid, method of using and dosage of high Xin, a Chinese family name or west ground.
The ⑺ adrenal glands skin quality hormone:
Ameliorable myocardial metabolism, lower the surroundings afferent tension, relieve bronchus spasm, the in common use vein drop notes ground to fill a rice loose
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