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慢性难治性充血性心力衰竭的处理是基于对有关病理生理机理的坚实的知识,识别有关心脏病的特定类型,以及纠正可能致使治疗反应不佳的各种心外因素。一般,应予心导管检查以确定心脏病的原因和了解心室功能异常的程度。严重心脏功能不全的治疗需要精巧地纠正泵功能四个主要决定因素的紊乱:(1)前负荷,(2)后负荷,(3)收缩力,和(4)心率。因此,不适应手术治疗的严重慢性充血性心力衰竭的内科治疗,通常是一种综合治疗:用洋地黄和多巴胺以增强受抑的收缩能状态;用利尿剂和硝酸酯类以减轻循环充血;如需要,则予扩张容量以维持心室充盈压在正常的高限而提供合适的前负荷;用硝普钠扩张体循环血管,降低增高了的心室后负荷,用抗心律失常药、直流电击复律和起搏器建立正常的心室率和心律。在冠心病中,尚需考虑治疗对心肌氧耗量的影响。
The treatment of chronic refractory congestive heart failure is based on a solid knowledge of the pathophysiological mechanisms, the identification of specific types of heart disease, and the correction of a variety of extra-cardiac factors that may lead to poor response to treatment. In general, catheterization should be performed to determine the cause of heart disease and to understand the extent of ventricular dysfunction. The treatment of severe cardiac insufficiency needs to finely correct the disorders of the four major determinants of pump function: (1) preload, (2) postload, (3) contractility, and (4) heart rate. Therefore, medical treatment of severe chronic congestive heart failure that is not suitable for surgery is usually a combination of treatment with digitalis and dopamine to enhance the contractile state of inhibition; diuretics and nitrates to reduce circulatory congestion; If necessary, the volume is expanded to maintain the normal high limit of ventricular filling to provide a suitable pre-load; with nitroprusside to dilate the blood vessels and reduce the increased post-ventricular load, with anti-arrhythmic drugs, DC cardioversion And pacemaker to establish normal ventricular rate and heart rate. In coronary heart disease, still need to consider the impact of treatment on myocardial oxygen consumption.