不同病因重症心力衰竭的急诊救治——103例心力衰竭患者临床观察

Clinical observation on emergency treatment to severe heart failure in different pathogeny

目的针对不同病因导致重症心力衰竭采用不同急诊治疗方法的临床疗效观察。方法对收治的103例重症心衰病人根据病史、临床表现及超声心动结果进行分组，采用不同的药物治疗方案：A组．慢性收缩性心力衰竭急性失代偿期应用硝普钠＋小剂量多巴胺；B组，风心病二尖瓣狭窄合并右心衰竭伴重度水肿应用大剂量利尿剂；C组，肺心病右心衰竭失代偿期应用乌拉地尔联合氨力农治疗；D组，扩张型心肌病心力衰竭晚期应用多巴酚丁胺及利尿剂治疗。监测治疗前后1—2wk心功能分级（NYHA）、血压、心率、体重、脉搏血氧饱和度、左室射血分数的变化。结果各组在治疗前后1—2wk，临床症状改善、各项主要指标在统计学上有显著性差异。结论针对不同病因的心衰病人，采用不同的治疗方法，是急诊救治重症心力衰竭患者的有效方法。

Objective To observe the therapeutic effects of the different treatment to severe heart failure with different pathogeny. Methods 103 patients with severe heart failure, were divided into four groups by the historic, clinical symptom and echocardiography, gave different treatment to each group： patients with chronic contractive heart failure during worsen process gave sodium nitroprusside and dopamine in little dose; patients with rheumatic heart disease, mitral stenosis,right ventricle of heart failure and severe oedema gave booster dose of furosemide; patients with right ventricle of heart failure caused by chronic pulmonary heart disease, gave urapidil hydrochloride and amrinone; severe heart failure caused by dilated cardiomyopathy gave the treatment of dobutamine and furosemide, the patients were followed up for one or two weeks, including their heart function （NYHA）,SBP,DBP,HR,weight,SpO2,and LVEF by echocardiography, combined the data with t-test. Results To the patients in each group, the treatment contains for one to two weeks, clinical symptom were better and the data were significant differences after the treatment. Conclusion Selecting different drugs to the severe heart failure patients with different pathogeny is valid remedy in emergency department.