27心力衰竭.ppt

第十三章心功能不全 Introduction Causes of Heart Failure Classification of Heart Failure Compensatory mechanism in Heart Failure Pathogenesis of Heart Failure Functional metabolic alterations in Heart Failure Treatment principles of Heart Failure 概述 心功能不全的病因与诱因 心功能不全的分类 心功能不全时机体的代偿 心力衰竭的发生机制 心功能不全的临床表现及其病理生理基础 心功能不全防治的病理生理基础 心力衰竭Heart failure 心力衰竭的定义 Heart failure may be defined as the condition in which the heart is no longer able to pump an adequate supply of blood for the metabolic needs of the body, provided there is adequate venous return to the heart. Heart failure is not a disease; it is a consequence of diseases that impair the ability of the heart to function as a pump. 心力衰竭的定义 在各种致病因素的作用下，心脏的收缩和／或舒张功能发生障碍，即心脏泵血功能发生障碍，使心输出量绝对或相对不足，不能充分满足机体代谢需要的病理过程或综合征称为心力衰竭。 Myocardial failure （心肌衰竭） Congestive heart failure （充血性心力衰竭） Cardiac dysfunction（心功能不全） 充血性心力衰竭 心力衰竭呈慢性经过时，由于心输出量与静脉回流量不相适应，导致钠、水潴留和血容量增多，使静脉淤血及组织间液增加，出现明显组织水肿，心腔通常也扩大，称为充血性心力衰竭。 Congestive heart failure usually has a chronic course with an abnormal accumulation of fluid, which results in the expansion of intravascular blood volume. 心力衰竭的病因 Basic causes 一．Dysfunction of myocardium 1．Diffuse myocardial damage 2．Myocardial ischemia and hypoxia 二．Overload for myocardium 1． excessive pressure load（压力负荷过度） 2． excessive volume load（容量负荷过度） 三．Limited diastole Precipitating causes Infection Arrhythmias pulmonary embolism 心力衰竭的分类 Acute versus chronic heart failure High-output versus low-output heart failure Right-sided versus left-sided heart failure Contractive versus diastolic heart failure 高输出量性心力衰竭 High output heart failure 继发于代谢增高或某些心脏前负荷增高的疾病，如甲亢、严重贫血、维生素B1缺乏和动静脉瘘等。心衰发生时患者的心输出量较发生前明显降低，但其绝对值可等于或高于正常人水平，尽管如此，仍不能满足患者器官、组织的代谢需要，称为高输出量性心力衰竭。 The cardiac output tends to be elevated in patients with heart failure secondary to hyperthyroidism, anemia, arteriovenous fistulas, beriberi. Compensatory mechanism in Heart Failure 1．Increased release of catecholamines by