Albert Nancy M
Division of Nursing and CNS, George M. and Linda H. Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Cardiovasc Nurs. 2004 Nov-Dec;19(6 Suppl):S11-26. doi: 10.1097/00005082-200411001-00003.
Left-ventricular systolic dysfunction, or heart failure (HF), is a chronic, progressive condition with a poor prognosis. Approximately 50% of deaths, especially in mild to moderate cases, are sudden. Most sudden deaths are thought to be due to ventricular tachycardia; however, premature ventricular contractions and couplets parallel severity of HF and have been associated with increased mortality risk as opposed to dysrhythmic death. Ventricular arrhythmogenesis results from many mechanisms (afterdepolarizations, reentry, and enhanced automaticity) and preconditions (electrophysiologic abnormalities, neuroendocrine activation, electrolyte imbalances, scar from an ischemic event in ischemic cardiomyopathy, fibrosis in dilated cardiomyopathy, hemodynamic abnormalities, and HF medical management). Nurses are key caregivers in optimally managing HF, either by direct actions or by using advocacy, communication, and collaboration skills to promote positive outcomes. Ventricular dysrhythmia management consists of facilitating core HF pharmacologic and nonpharmacologic medical therapies, using amiodarone to improve symptoms, as needed, and utilizing implantable cardioverter-defibrillator therapy to reduce the risk of sudden cardiac death.
左心室收缩功能障碍，即心力衰竭（HF），是一种慢性进行性疾病，预后较差。约50%的死亡病例，尤其是轻至中度病例，为猝死。大多数猝死被认为是由室性心动过速所致；然而，室性早搏和成对早搏与HF的严重程度平行，并且与死亡风险增加相关，这与心律失常性死亡不同。室性心律失常的发生由多种机制（后除极、折返和自律性增强）和先决条件（电生理异常、神经内分泌激活、电解质失衡、缺血性心肌病中缺血事件所致瘢痕、扩张型心肌病中的纤维化、血流动力学异常以及HF的药物治疗）引起。护士是优化HF管理的关键照护者，可通过直接行动或运用支持、沟通及协作技能来促进积极的结果。室性心律失常的管理包括促进HF核心药物和非药物治疗、必要时使用胺碘酮改善症状以及采用植入式心脏复律除颤器治疗以降低心源性猝死风险。
