Widmer Fritz
Medizinische Klinik, Kardiologie, Kantonsspital Münsterlingen.
Ther Umsch. 2011 Feb;68(2):103-6. doi: 10.1024/0040-5930/a000127.
Noncardiac Comorbidities are frequent and may be overlooked during routine CHF management. They have great impact on hospitalisations and mortality. The most important comorbidities in heart failure patients are renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease, sleeping disorders like obstructive and central apnea syndrom, and anemia. The most powerful predictor for mortality is renal insufficiency. It's important to recognize the different causes of renal failure. Defining the volume status and the cardiac output is crucial for the guidance of therapy. The management of diuretic resistance is of special interest and often challenging. Diabetes mellitus is an independent risk factor for heart failure. The benefit of ACE inhibitors and Angiotensin receptor blockers for HF and DM is accepted. The management of Diabetes in HF depends on side-effect profiles of the numerous anti-diabetic drugs. Metformin is safe even in HF patients. Thiazolidinediones should be avoided in NYHA class III/IV because of fluid retention. In COPD patients there is an underuse of betablockers and the prediction of mortality with this comorbidity could be partially caused by that. The principle goal of treatment of sleeping disorders is to avoid hypoxia during night. CPAP therapy improves live quality and HF symptoms. Anemia is often diagnosed, the best therapy - erythropoetin plus iron or iron alone - remains controversial. Iron supplementation without anemia could be an option for better quality of life. To handle all these comorbidities in heart failure patients becomes more and mor complex. Heart failure nurses can help us to manage these growing population.
非心脏合并症很常见，在常规慢性心力衰竭管理过程中可能被忽视。它们对住院率和死亡率有很大影响。心力衰竭患者最重要的合并症是肾功能不全、糖尿病、慢性阻塞性肺疾病、阻塞性和中枢性呼吸暂停综合征等睡眠障碍以及贫血。死亡率最强的预测因素是肾功能不全。认识到肾衰竭的不同病因很重要。确定容量状态和心输出量对指导治疗至关重要。利尿剂抵抗的管理特别受关注且往往具有挑战性。糖尿病是心力衰竭的独立危险因素。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对心力衰竭和糖尿病的益处已得到认可。心力衰竭患者糖尿病的管理取决于众多抗糖尿病药物的副作用情况。二甲双胍即使在心力衰竭患者中也是安全的。由于液体潴留，纽约心脏协会心功能Ⅲ/Ⅳ级患者应避免使用噻唑烷二酮类药物。在慢性阻塞性肺疾病患者中，β受体阻滞剂使用不足，这种合并症导致的死亡率预测可能部分由此引起。睡眠障碍治疗的主要目标是避免夜间缺氧。持续气道正压通气治疗可改善生活质量和心力衰竭症状。贫血常被诊断出来，最佳治疗方法——促红细胞生成素加铁剂或仅用铁剂——仍存在争议。无贫血时补充铁剂可能是改善生活质量的一种选择。处理心力衰竭患者的所有这些合并症变得越来越复杂。心力衰竭护士可以帮助我们管理这些不断增加的患者群体。
