文档介绍：慢性心力衰竭诊断 与治疗的新进展北京协和医院心内科严晓伟冠脉血栓形成猝死心力衰竭死亡神经内分泌活化心肌缺血冠状动脉病变粥样硬化左心室肥厚危险因子高血压,高脂血,糖尿病,;121:,新病例40万-70万/年国内资料10个省市,%,%男性:%,女性:%1980、1990、2000住院心衰患者回顾调查风心病构成比下降约50%,冠心病上升为首位病因中华心血管病杂志,2003,31:3-6CardiorenalDigitalisanddiuretictoperfusekidneysHemodynamicVasodilatorsorpositiveinotropestorelieveventricularwallstressNeurohormonalACEinhibitors,betablockers,andotheragentstoblockneurohormonalactivation1940s 1960s 1970s 1990s-2000Pepper,;88:2–(pg/mL)NLHF血浆肾素激活(ng/mL/h)15129630NLHF精氨酸血管加压素(pg/mL)126420NLHF心房钠尿肽(pg/mL)300250200150100500NLHF内皮素-1(pg/mL)86420NLHF6005004003002001000心衰神经激素激活V-HeFTII研究 血浆去甲肾上腺素与病死率的相关性累计病死率(%)018304260月10080604020061224364854PNE>900pg/mlPNE600–900pg/mlPNE<600pg/mlTwoyearp<<-(1993)累积存活率Logranktest;p<,Chi=(天)<(劳力性、端坐呼吸、肺水肿)LVEF<50%LVEF≥50%收缩性心力衰竭舒张性心力衰竭除外肺部疾病、贫血等非心脏原因引起的呼吸困难脑钠肽(BNP)对心力衰竭的诊断价值--是否存在心力衰竭