{"id":36510,"date":"2024-06-09T04:01:32","date_gmt":"2024-06-09T04:01:32","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=36510"},"modified":"2024-06-09T04:01:32","modified_gmt":"2024-06-09T04:01:32","slug":"%e6%9c%80%e6%96%b0%e6%8c%87%e5%8d%97-%e4%b8%ad%e5%9b%bd%e5%bf%83%e5%8a%9b%e8%a1%b0%e7%ab%ad%e5%9f%ba%e5%b1%82%e8%af%8a%e6%96%ad%e4%b8%8e%e6%b2%bb%e7%96%97%e6%8c%87%e5%8d%97%ef%bc%882024%e5%b9%b4","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=36510","title":{"rendered":"\u6700\u65b0\u6307\u5357 | \u4e2d\u56fd\u5fc3\u529b\u8870\u7aed\u57fa\u5c42\u8bca\u65ad\u4e0e\u6cbb\u7597\u6307\u5357\uff082024\u5e74\uff09"},"content":{"rendered":"<p>\u6982 \u8ff0<\/p>\n<ul>\n<li>\n<p>\u5fc3\u8870\u662f\u7531\u5fc3\u810f\u7ed3\u6784\u548c\/\u6216\u529f\u80fd\u5f02\u5e38\u5f15\u8d77\u7684\u590d\u6742\u4e34\u5e8a\u7efc\u5408\u5f81<\/p>\n<\/li>\n<li>\n<p>\u4e2d\u56fd\u5fc3\u8870\u60a3\u75c5\u7387\u9010\u5e74\u4e0a\u5347\uff0c\u5c24\u5176\u662f\u5728\u8001\u5e74\u4eba\u7fa4\u4e2d<\/p>\n<\/li>\n<li>\n<p>\u6309\u5de6\u5fc3\u5ba4\u5c04\u8840\u5206\u6570\uff08left ventricular ejection fraction\uff0cLVEF\uff09\u8fdb\u884c\u5206\u7c7b\uff0c\u5fc3\u8870\u5206\u4e3a\u5c04\u8840\u5206\u6570\u964d\u4f4e\u7684\u5fc3\u8870\uff08heart failure with reduced ejection fraction\uff0cHFrEF\uff09\u3001\u5c04\u8840\u5206\u6570\u6539\u5584\u7684\u5fc3\u8870\uff08heart failure with improved ejection fraction\uff0cHFimpEF\uff09\u3001\u5c04\u8840\u5206\u6570\u8f7b\u5ea6\u964d\u4f4e\u7684\u5fc3\u8870\uff08heart failure with mildly reduced ejection fraction\uff0cHFmrEF\uff09\u548c\u5c04\u8840\u5206\u6570\u4fdd\u7559\u7684\u5fc3\u8870\uff08heart failure with preserved ejection fraction\uff0cHFpEF\uff09<\/p>\n<\/li>\n<li>\n<p>\u6309\u53d1\u75c5\u65f6\u95f4\u548c\u8fdb\u5c55\u901f\u5ea6\u8fdb\u884c\u5206\u7c7b\uff0c\u5fc3\u8870\u5206\u4e3a\u6162\u6027\u5fc3\u8870\u548c\u6025\u6027\u5fc3\u8870<\/p>\n<\/li>\n<li>\n<p>\u5fc3\u8870\u7684\u53d1\u5c55\u53ef\u5206\u4e3aA\u3001B\u3001C\u3001D 4\u4e2a\u9636\u6bb5\uff0c\u5f3a\u8c03\u5fc3\u8870\u9884\u9632\u3001\u65e9\u671f\u8bca\u65ad\u7684\u91cd\u8981\u6027<\/p>\n<\/li>\n<\/ul>\n<p>\u75c5\u56e0\u53ca\u8bf1\u56e0<\/p>\n<ul>\n<li>\u5fc3\u8870\u7684\u4e3b\u8981\u75c5\u56e0\u5305\u62ec\u51a0\u5fc3\u75c5\u3001\u9ad8\u8840\u538b\u3001\u6269\u5f20\u578b\u5fc3\u808c\u75c5\u548c\u5fc3\u810f\u74e3\u819c\u75c5\u7b49<\/li>\n<li>\u5fc3\u8870\u60a3\u8005\u5e38\u5408\u5e76\u5fc3\u623f\u98a4\u52a8\u3001\u7cd6\u5c3f\u75c5\u3001\u8d2b\u8840\u3001\u6162\u6027\u80be\u810f\u75c5<\/li>\n<li>\n<p>\u5fc3\u8870\u53ef\u7531\u611f\u67d3\u3001\u5fc3\u5f8b\u5931\u5e38\u3001\u80ba\u6813\u585e\u7b49\u56e0\u7d20\u8bf1\u53d1<\/p>\n<\/li>\n<\/ul>\n<p>\u8bca\u65ad\u53ca\u75c5\u60c5\u8bc4\u4f30<\/p>\n<ul>\n<li>\u5fc3\u8870\u8bca\u65ad\u5e94\u57fa\u4e8e\u75c5\u53f2\u3001\u4f53\u683c\u68c0\u67e5\u548c\u8f85\u52a9\u68c0\u67e5\uff08\u2160\uff0cC\uff09<\/li>\n<li>\u5fc3\u8870\u7684\u4e3b\u8981\u75c7\u72b6\u5305\u62ec\u547c\u5438\u56f0\u96be\u3001\u75b2\u4e4f\u548c\u6c34\u80bf<\/li>\n<li>\n<p>\u5fc3\u8870\u8bca\u65ad\u53ca\u8bc4\u4f30\u7684\u5e38\u89c4\u68c0\u67e5\u5305\u62ec\u5fc3\u7535\u56fe\uff08\u2160\uff0cC\uff09\u3001\u80f8\u90e8X\u7ebf\u7247\uff08\u2160\uff0cC\uff09\u3001\u8840\u53ca\u5c3f\u6db2\u5206\u6790\uff08\u2160\uff0cC\uff09\u3001\u5229\u94a0\u80bd\u68c0\u6d4b\uff08\u2160\uff0cA\uff09\u3001\u8d85\u58f0\u5fc3\u52a8\u56fe\uff08\u2160\uff0cC\uff09<\/p>\n<\/li>\n<\/ul>\n<p>\u5fc3\u8870\u7684\u9884\u9632<\/p>\n<ul>\n<li>\u9ad8\u5371\u4eba\u7fa4\u5e94\u5b9a\u671f\u8fdb\u884c\u5fc3\u8870\u98ce\u9669\u8bc4\u4f30\uff0c\u5e76\u901a\u8fc7\u6539\u5584\u751f\u6d3b\u65b9\u5f0f\u8fdb\u884c\u7ba1\u7406<\/li>\n<li>\u5e94\u6309\u76f8\u5173\u6307\u5357\u63a7\u5236\u5fc3\u8870\u5371\u9669\u56e0\u7d20\uff0c\u5305\u8840\u538b\u3001\u8840\u7cd6\u3001\u8840\u8102\u7b49<\/li>\n<li>\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e94\u4f7f\u7528\u94a0\u2011\u8461\u8404\u7cd6\u534f\u540c\u8f6c\u8fd0\u86cb\u767d\u20112\u6291\u5236\u5242\uff08sodium\u2011glucose cotransporter 2 inhibitor\uff0cSGLT\u20112i\uff09\uff08\u2160\uff0cA\uff09<\/li>\n<li>\n<p>\u5bf9\u4e8e\u65e0\u75c7\u72b6\u6027\u5de6\u5fc3\u5ba4\u529f\u80fd\u969c\u788d\u7684\u60a3\u8005\uff0c\u5e94\u4f7f\u7528\u8840\u7ba1\u7d27\u5f20\u7d20\u8f6c\u5316\u9176\u6291\u5236\u5242\uff08angiotensin converting enzyme inhibitor\uff0cACEI\uff09\u548c\u03b2\u53d7\u4f53\u963b\u6ede\u5242\uff08\u2160\uff0cA\uff09\uff1b\u4e0d\u80fd\u8010\u53d7ACEI\u8005\u5e94\u4f7f\u7528\u8840\u7ba1\u7d27\u5f20\u7d20\u2161\u53d7\u4f53\u963b\u6ede\u5242\uff08angiotensin \u2161 receptor antagonists\uff0cARB\uff09\uff08\u2160\uff0cB\uff09<\/p>\n<\/li>\n<\/ul>\n<p>\u5fc3\u8870\u7684\u4e00\u822c\u6cbb\u7597<\/p>\n<ul>\n<li>\u5fc3\u8870\u60a3\u8005\u5e94\u4fdd\u6301\u5065\u5eb7\u751f\u6d3b\u65b9\u5f0f\uff0c\u9650\u5236\u94a0\u6444\u5165\u548c\u6db2\u4f53\u6444\u5165\uff0c\u4f4e\u8102\u996e\u98df\uff0c\u6212\u70df\u9650\u9152\uff0c\u9002\u5ea6\u6d3b\u52a8<\/li>\n<li>\u5e94\u7ed9\u4e88\u5fc3\u8870\u60a3\u8005\u5fc3\u7406\u652f\u6301\uff0c\u82e5\u60a3\u8005\u5b58\u5728\u6291\u90c1\u3001\u7126\u8651\uff0c\u5e94\u53ca\u65f6\u8fdb\u884c\u5e72\u9884<\/li>\n<li>\n<p>\u5fc3\u8870\u60a3\u8005\u5e94\u63a5\u79cd\u80ba\u708e\u3001\u6d41\u611f\u548c\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u611f\u67d3\uff08COVID\u201119\uff09\u75ab\u82d7\u7b49\uff0c\u4ee5\u9884\u9632\u611f\u67d3<\/p>\n<\/li>\n<\/ul>\n<p>\u6162\u6027\u5fc3\u8870\u7684\u6cbb\u7597<\/p>\n<p>1<\/p>\n<p>HFrEF\u7684\u836f\u7269\u6cbb\u7597<\/p>\n<p>1\u3001\u5229\u5c3f\u5242<\/p>\n<ul>\n<li>\u5229\u5c3f\u5242\u7528\u4e8e\u7f13\u89e3\u5fc3\u8870\u75c7\u72b6\uff08\u2160\uff0cC\uff09<\/li>\n<li>\u6839\u636e\u60a3\u8005\u7684\u6db2\u4f53\u6f74\u7559\u60c5\u51b5\u3001\u8840\u538b\u548c\u80be\u529f\u80fd\u9009\u62e9\u5229\u5c3f\u5242\u548c\u8c03\u6574\u5242\u91cf\uff0c\u5e76\u76d1\u6d4b\u5c3f\u91cf\u548c\u4f53\u91cd<\/li>\n<li>\n<p>\u6ce8\u610f\u7535\u89e3\u8d28\u5931\u8861\u3001\u4f4e\u8840\u538b\u3001\u80be\u529f\u80fd\u6076\u5316\u7684\u98ce\u9669\uff0c\u9002\u5f53\u76d1\u6d4b<\/p>\n<\/li>\n<\/ul>\n<p>2\u3001\u80be\u7d20\u2011\u8840\u7ba1\u7d27\u5f20\u7d20\u2011\u919b\u56fa\u916e\u7cfb\u7edf\uff08renin\u2011angiotensin\u2011aldosterone system\uff0cRAAS\uff09\u6291\u5236\u5242<\/p>\n<ul>\n<li>\u63a8\u8350\u4f7f\u7528RAAS\u6291\u5236\u5242\uff08ARNI\/ACEI\/ARB\uff09\u6539\u5584HFrEF\u60a3\u8005\u5fc3\u810f\u91cd\u6784\uff0c\u964d\u4f4e\u5176\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u548c\u4f4f\u9662\u98ce\u9669\uff08\u2160\uff0cA\uff09<\/li>\n<li>\u5e94\u6839\u636e\u60a3\u8005\u7684\u8010\u53d7\u6027\u548c\u75c7\u72b6\u9009\u62e9\u9002\u5f53\u7684RAAS\u6291\u5236\u5242\uff0c\u9010\u6e10\u589e\u52a0\u5242\u91cf\u4ee5\u8fbe\u5230\u76ee\u6807\u5242\u91cf\uff0c\u5e76\u957f\u671f\u4f7f\u7528<\/li>\n<li>\u5e94\u76d1\u6d4b\u60a3\u8005\u7684\u8840\u538b\u3001\u80be\u529f\u80fd\u548c\u7535\u89e3\u8d28\uff0c\u5fc5\u8981\u65f6\u8c03\u6574RAAS\u6291\u5236\u5242\u7684\u5242\u91cf<\/li>\n<\/ul>\n<p>3\u3001\u03b2\u53d7\u4f53\u963b\u6ede\u5242<\/p>\n<ul>\n<li>\u7a33\u5b9a\u7684HFrEF\u60a3\u8005\u5e94\u4f7f\u7528\u03b2\u53d7\u4f53\u963b\u6ede\u5242\u4ee5\u964d\u4f4e\u5fc3\u8870\u4f4f\u9662\u548c\u6b7b\u4ea1\u98ce\u9669\uff0c\u9664\u975e\u6709\u7981\u5fcc\u8bc1\u6216\u4e0d\u80fd\u8010\u53d7\uff08\u2160\uff0cA\uff09<\/li>\n<li>\u5177\u6709\u9002\u5e94\u8bc1\u7684HFrEF\u60a3\u8005\uff0c\u5e94\u5c3d\u65e9\u4f7f\u7528\u03b2\u53d7\u4f53\u963b\u6ede\u5242\uff0c\u4ee5\u5c0f\u5242\u91cf\u8d77\u59cb\uff0c\u9010\u6e10\u6ef4\u5b9a\u81f3\u76ee\u6807\u5242\u91cf\u6216\u6700\u5927\u8010\u53d7\u5242\u91cf\u540e\u957f\u671f\u7ef4\u6301\u4f7f\u7528<\/li>\n<li>\u4f7f\u7528\u03b2\u53d7\u4f53\u963b\u6ede\u5242\u671f\u95f4\uff0c\u5e94\u76d1\u6d4b\u5fc3\u7387\u548c\u8840\u538b\uff0c\u60a3\u8005\u51fa\u73b0\u5fc3\u52a8\u8fc7\u7f13\u6216\u4f4e\u8840\u538b\u65f6\u5e94\u9002\u5f53\u8c03\u6574\u5242\u91cf<\/li>\n<\/ul>\n<p>4\u3001MRA<\/p>\n<ul>\n<li>\u5bf9\u4e8e\u6709\u75c7\u72b6\u7684HFrEF\u60a3\u8005\u63a8\u8350\u4f7f\u7528MRA\uff0c\u4ee5\u964d\u4f4e\u5fc3\u8870\u4f4f\u9662\u548c\u6b7b\u4ea1\u98ce\u9669\uff08\u2160\uff0cA\uff09<\/li>\n<li>MRA\u8d77\u59cb\u5242\u91cf\u5e94\u8c28\u614e\uff0c\u5e94\u9010\u6b65\u6ef4\u5b9a\u81f3\u76ee\u6807\u5242\u91cf\uff0c\u5e76\u5b9a\u671f\u76d1\u6d4b\u8840\u94be\u548c\u80be\u529f\u80fd<\/li>\n<li>\u6ce8\u610f\u80be\u529f\u80fd\u6076\u5316\u548c\u9ad8\u94be\u8840\u75c7\u98ce\u9669\uff0c\u5e94\u907f\u514d\u540c\u65f6\u4f7f\u7528\u8865\u94be\u5242<\/li>\n<\/ul>\n<p>5\u3001SGLT\u20112i<\/p>\n<ul>\n<li>\u6709\u75c7\u72b6\u7684HFrEF\u60a3\u8005\u5e94\u4f7f\u7528SGLT\u20112i\uff0c\u4ee5\u964d\u4f4e\u5fc3\u8870\u52a0\u91cd\u548c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u98ce\u9669\uff08\u2160\uff0cA\uff09<\/li>\n<li>\u4f7f\u7528\u671f\u95f4\u9700\u5b9a\u671f\u76d1\u6d4b\u80be\u529f\u80fd\u548c\u8840\u7cd6\u6c34\u5e73\uff0c\u6ce8\u610f\u6ccc\u5c3f\u751f\u6b96\u7cfb\u7edf\u611f\u67d3\u3001\u5bb9\u91cf\u72b6\u6001\u3001\u916e\u75c7\u9178\u4e2d\u6bd2\u75c7\u72b6\uff0c\u5fc5\u8981\u65f6\u8c03\u6574\u6cbb\u7597\u65b9\u6848<\/li>\n<\/ul>\n<p>6\u3001\u65b0\u578b\u53ef\u6eb6\u6027\u9e1f\u82f7\u9178\u73af\u5316\u9176\uff08soluble guanylate cyclase\uff0csGC\uff09\u523a\u6fc0\u5242<\/p>\n<ul>\n<li>\u5bf9\u8fd1\u671f\u5fc3\u8870\u52a0\u91cd\u7684LVEF&lt;45%\u7684\u5fc3\u8870\u60a3\u8005\uff0c\u53ef\u8003\u8651\u4f7f\u7528\u7ef4\u7acb\u897f\u5471\uff0c\u4ee5\u964d\u4f4e\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u548c\u5fc3\u8870\u4f4f\u9662\u98ce\u9669\uff08\u2161a\uff0cB\uff09<\/li>\n<li>\u7ef4\u7acb\u897f\u5471\u8d77\u59cb\u5242\u91cf\u4e3a2.5mg\/d\uff0c\u9010\u6b65\u6ef4\u5b9a\u81f310mg\/d<\/li>\n<li>\u598a\u5a20\u671f\u5987\u5973\u3001\u4e25\u91cd\u80be\u529f\u80fd\u4e0d\u5168\u4ee5\u53ca\u75c7\u72b6\u6027\u4f4e\u8840\u538b\u60a3\u8005\u907f\u514d\u4f7f\u7528sGC\u523a\u6fc0\u5242<\/li>\n<\/ul>\n<p>7\u3001\u4f0a\u4f10\u5e03\u96f7\u5b9a<\/p>\n<ul>\n<li>\u5bf9\u4e8e\u5df2\u4f7f\u7528GDMT\uff0c\u4f46\u5fc3\u7387\u4ecd\u226570\u6b21\/min\u7684\u7aa6\u6027\u5fc3\u5f8b\u7684HFrEF\u60a3\u8005\uff0c\u5f53\u03b2\u53d7\u4f53\u963b\u6ede\u5242\u8fbe\u5230\u63a8\u8350\u5242\u91cf\u6216\u6700\u5927\u8010\u53d7\u5242\u91cf\uff08\u2161a\uff0cB\uff09\u6216\u5b58\u5728\u4e0d\u8010\u53d7\u65f6\uff08\u2161a\uff0cC\uff09\uff0c\u53ef\u8003\u8651\u4f7f\u7528\u4f0a\u4f10\u5e03\u96f7\u5b9a\uff0c\u4ee5\u964d\u4f4e\u5fc3\u8870\u4f4f\u9662\u548c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u98ce\u9669<\/li>\n<li>\u9700\u6839\u636e\u5fc3\u7387\u8c03\u6574\u4f0a\u4f10\u5e03\u96f7\u5b9a\u7684\u4f7f\u7528\u5242\u91cf\uff0c\u4ee5\u4f7f\u9759\u606f\u5fc3\u7387\u7ef4\u6301\u572855~60\u6b21\/min<\/li>\n<\/ul>\n<p>8\u3001\u6d0b\u5730\u9ec4\u7c7b\u836f\u7269<\/p>\n<ul>\n<li>\u5bf9\u4e8e\u5df2\u4f7f\u7528GDMT\u540e\u4ecd\u6709\u75c7\u72b6\u7684HFrEF\u60a3\u8005\uff0c\u53ef\u4f7f\u7528\u5730\u9ad8\u8f9b\uff0c\u4ee5\u51cf\u5c11\u5fc3\u8870\u4f4f\u9662\u98ce\u9669\uff08\u2161a\uff0cB\uff09<\/li>\n<li>\u63a8\u8350\u5242\u91cf\u4e3a0.125~0.25mg\/d\uff0c\u4f7f\u7528\u671f\u95f4\u9700\u76d1\u6d4b\u8840\u836f\u6d53\u5ea6\uff08\u7ef4\u6301\u57280.5~0.9\u03bcg\/L\uff09\u3001\u80be\u529f\u80fd\u548c\u7535\u89e3\u8d28<\/li>\n<li>\n<p>\u4f7f\u7528\u671f\u95f4\u9700\u76d1\u6d4b\u4e0d\u826f\u53cd\u5e94\u5305\u62ec\u5fc3\u5f8b\u5931\u5e38\u3001\u80c3\u80a0\u9053\u75c7\u72b6\u548c\u795e\u7ecf\u7cbe\u795e\u75c7\u72b6\u7b49<\/p>\n<\/li>\n<\/ul>\n<p>2<\/p>\n<p>HFrEF\u7684\u5fc3\u810f\u690d\u5165\u578b\u7535\u5b50\u5668\u68b0\u6cbb\u7597<\/p>\n<ul>\n<li>\u9700\u719f\u6089HFrEF\u7684\u5668\u68b0\u690d\u5165\u6307\u5f81\uff0c\u5bf9\u6709\u4ecb\u5165\u6307\u5f81\u7684\u60a3\u8005\u5efa\u8bae\u8f6c\u81f3\u4e0a\u7ea7\u533b\u9662\u7684\u5fc3\u8840\u7ba1\u4e13\u79d1\u8bc4\u4f30\u3001\u6cbb\u7597\uff0c\u75c5\u60c5\u7a33\u5b9a\u540e\u8f6c\u56de\u57fa\u5c42\u533b\u7597\u673a\u6784\u7ee7\u7eed\u968f\u8bbf\u7ba1\u7406<\/li>\n<li>\u5bf9\u4e8e\u4f18\u5316GDMT3~6\u4e2a\u6708\u540e\u4ecd\u6709\u75c7\u72b6\uff0c\u7aa6\u6027\u5fc3\u7387\uff0cLVEF\u226435%\uff0c\u5b58\u5728\u5de6\u675f\u652f\u4f20\u5bfc\u963b\u6ede\uff0cQRS\u65f6\u9650\u2265150ms\u7684\u60a3\u8005\uff0c\u63a8\u8350\u8fdb\u884c\u5fc3\u810f\u518d\u540c\u6b65\u5316\u6cbb\u7597\uff08cardiac resynchronization therapy\uff0cCRT\uff09\uff0c\u4ee5\u6539\u5584\u751f\u6d3b\u8d28\u91cf\uff0c\u964d\u4f4e\u5fc3\u8870\u4f4f\u9662\u548c\u6b7b\u4ea1\u98ce\u9669\uff08\u2160\uff0cA\uff09<\/li>\n<li>\n<p>\u5bf9\u4e8e\u53d1\u751f\u8fc7\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u5ba4\u6027\u5fc3\u5f8b\u5931\u5e38\u60a3\u8005\uff0c\u6216\u8005LVEF\u226435%\uff0cNYHA\u5fc3\u529f\u80fd\u2161~\u2162\u7ea7\u7684HFrEF\u60a3\u8005\uff0c\u63a8\u8350\u690d\u5165\u690d\u5165\u5f0f\u5fc3\u5f8b\u8f6c\u590d\u9664\u98a4\u5668\uff08implantable cardioverter 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