Dracup K, Baker D W, Dunbar S B, Dacey R A, Brooks N H, Johnson J C, Oken C, Massie B M
UCLA School of Nursing 90024-6918.
JAMA. 1994 Nov 9;272(18):1442-6. doi: 10.1001/jama.1994.03520180066037.
This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction.
We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, < 0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed.
Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.
本文综述了咨询、教育、饮食调整及运动对左心室收缩功能障碍所致心力衰竭患者的作用。
我们查阅了1966年至1993年间以英文发表并被MEDLINE或EMBASE收录的研究。我们使用了心力衰竭、充血性；充血性心力衰竭；心力衰竭；心功能不全；以及扩张型心肌病等检索词，并结合特定感兴趣领域的术语。在数据缺乏时，我们依据专家组成员和同行评审者的意见。研究选择与数据综合：对研究进行综述，以确定患者是否因收缩功能障碍（左心室射血分数<0.35至0.40）导致心力衰竭，以及是否报告了临床结局。仅报告中间结局（如血流动力学）的研究未纳入综述。
咨询和教育可改善患者结局并减少不必要的住院。轻度至中度心力衰竭患者最初应将钠摄入量限制在3g/d。对该剂量无反应或病情更严重的患者，建议钠摄入量为2g/d或更低。应强烈建议患者饮酒量不超过30mL/d，或最好完全戒酒。运动训练是安全的，可改善运动持续时间和症状。每次就诊时都应强调并监测对治疗计划的依从性。临床医生应告知患者其疾病的严重性及其预后，但应强调患者可以继续保持活动并享有合理的生活质量。
