Gaddam Krishna K, Yelamanchili Pridhvi, Sedghi Yabiz, Ventura Hector O
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2009 Winter;9(4):227-33.
The global healthcare burden attributable to heart failure is ever increasing. Patients presenting with refractory heart failure should be evaluated for compliance with medical regimens and sodium and/or fluid restriction, and every attempt should be made to optimize conventional strategies. Reversible causes such as ischemia should be identified and revascularization considered in persistently symptomatic patients, particularly those with a viable myocardium. Carefully selected patients who continue to deteriorate clinically in spite of optimization of medical therapy may be considered for advanced treatment strategies, such as continuous inotropic infusions, mechanical circulatory support devices, cardiac transplantation, or referral to hospice care. We discuss the clinical presentation and management of patients with advanced/refractory (Stage D) heart failure.
全球因心力衰竭导致的医疗负担不断增加。对于难治性心力衰竭患者，应评估其对药物治疗方案的依从性以及钠和/或液体限制情况，并应尽一切努力优化传统治疗策略。应识别出如缺血等可逆病因，对于持续有症状的患者，尤其是心肌仍存活的患者，应考虑进行血运重建。尽管优化了药物治疗，但仍在临床上持续恶化的精心挑选的患者，可考虑采用高级治疗策略，如持续静脉输注正性肌力药物、机械循环支持装置、心脏移植或转至临终关怀机构。我们讨论晚期/难治性（D期）心力衰竭患者的临床表现和管理。
