超高龄慢性心力衰竭急性加重1例

Acute aggravation of chronic heart failure in the elderly: a case report

慢性心力衰竭(简称心衰)急性加重是指持续性心力衰竭在某些诱因下恶化成为急性心衰,老年患者的再住院率和病死率均较高。本文报道1例既往冠状动脉三支病变未行经皮冠状动脉介入术或手术治疗,单纯药物治疗16年的超高龄慢性心衰患者,此次因心衰急性加重入院,诊断为:慢性心衰急性加重,心功能Ⅳ级(NYHA分级)、冠心病、陈旧性心肌梗死、高血压3级(极高危)、焦虑抑郁状态、睡眠障碍、陈旧性肺结核。予加强扩血管及利尿、抗心衰、抗凝、抗血小板、改善心肌代谢和供血、调脂稳定斑块等对症支持治疗,并加用小剂量沙库巴曲缬沙坦及尼可地尔,对延缓病情进展起到积极作用。

Acute exacerbation of chronic heart failure means that persistent heart failure worsens to acute heart failure under certain triggers,the readmission and mortality rates are higher in older patients.This paper reports a patient with chronic heart failure in the super-old age who had not received percutaneous coronary intervention or surgical treatment for three coronary artery lesions in the past 16 years and was admitted hospitalized for acute aggravation of heart failure.The diagnosis was as follows:acute exacerbation of chronic heart failure,heart function gradeⅣ(NYHA),coronary heart dis⁃ease,old myocardial infarction,hypertension grade 3(very high risk),anxiety and depression,sleep disorders,old tuber⁃culosis.Symptomatic supportive treatment such as strengthening vasodilation and diuresis,anti-heart failure,anti-coagula⁃tion,anti-platelet,improving myocardial metabolism and blood supply,lipid-stabilizing plaque,and adding small doses of sacubactrivalsartan and nicodil played a positive role in delaying the progression of the disease.