肺源性心脏病可能并发左心功能不全吗?如何制定治疗方案?

2021-12-21 中国医学论坛报今日循环 网络

患者以右心衰为主,先解决右心衰;如患者是以左心衰为主,就先解决左心衰。同时兼顾可能会导致主次不分。

 

提问

慢性肺源性心脏病可能并发左心功能不全吗?左右心室之间如何相互影响?治疗方案该如何选择?

 

复旦大学附属中山医院  周京敏教授
这一问题在临床上非常少见。
 
一般来说,慢性左心衰会继发肺动脉高压,而肺心病影响左心的极少。即使是非常严重的肺动脉高压,左心系统通常也不会受影响。
 
有严重肺心病同时又有严重左心衰的情况临床确实不多见。如果真出现了这种情况,治疗左心衰肯定更重要,因为动脉系统、重要脏器心、脑、肾的供血,都是来自左心。
 

右心衰表现为右心系统压力增高,患者颈静脉充盈、肝脏淤血、下肢浮肿,使用利尿剂可以解决。如果患者血压偏低,可以使用正性肌力药物如磷酸二酯酶抑制剂、左西孟旦等药物。但临床上也要因人而异。 

 

总体来说,临床问题很多,要抓主要矛盾。患者以右心衰为主,先解决右心衰;如患者是以左心衰为主,就先解决左心衰。同时兼顾可能会导致主次不分。

来源:沐雨  整理自壹生问答;周京敏教授  审校

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    2022-03-04 丁鹏鹏
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