急性心力衰竭急诊管理:未来已来  

Emergency management of acute heart failure:The future is here

作　　者：章晓红 李洋[3] 郑薇[1] ZHANG Xiaohong;LI Yang;ZHENG Wei(School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China;Department of Emergency Medicine,Sichuan Academy of Medical Sciences Provincial People’s Hospital,Chengdu 610072,China;Chengdu University of Tradi-tional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]电子科技大学医学院,成都611731 [2]四川省医学科学院·四川省人民医院急诊科,成都610072 [3]成都中医药大学,成都610075

出　　处：《西南医科大学学报》2023年第6期461-467,共7页Journal of Southwest Medical University

基　　金：四川省科技厅项目(2022JDKP0030);成都电子科技大学医学院2022年度课程思政建设项目(Y030222062001122)。

摘　　要：急性心力衰竭(acute heart failure,AHF)患者的治疗方式与近年来慢性心力衰竭患者诊疗管理方面取得的显著进展相比几乎没有改变。《急性心力衰竭中国急诊管理指南(2022)》在中国首次提出AHF急诊诊疗须兼具个体化全谱系管理和以患者生命支持为靶向的紧急救护;2023年8月25日,欧洲心脏病学会(European Society of Cardiology,ESC)心衰指南从心衰到合并症管理进行了多方位更新。2023 ESC指南亦推荐对病情已稳定,即将出院的AHF患者采取强化指南指导药物治疗(guideline-directed management and therapy,GDMT)与早期密切随访。两个指南为AHF急诊管理指明了未来研究重点和改进方向。本文在分析上述两个指南的基础上,就AHF相关的最新进展做一解读,相信未来指南的更新与落地能够进一步帮助提升AHF患者的GDMT滴定水平,更好的改善AHF患者临床结局,提升患者的生活质量。In contrast to significant advances in the management of patients with chronic heart failure over the past few years,there has been little change in how patients with acute heart failure are treated.“China Guidelines for emergencymanagement of Acute heart Failure(2022)”was proposed,for the first time in China,that emergency management of AHF should combine personalized full process management and emergency rescue targeting patient life support.On August 25,2023,the European Society of Cardiology(ESC)heart failure guidelines underwent comprehensive updates,covering various aspects from heart failure to the management of comorbidities.One of the core points of the 2023 ESC guidelines is also to emphasize the importance of the application of guidelinedirected medical therapy(GDMT)and early follow-up visit following discharge from either hospital or emergency department.Based on the analysis of the above two guidelines,evidence-based management of AHF was discussed in this review,including both pharmacologic and nonpharmacologic therapies,including the recent evidence regarding initiation of newer therapies in the emergency department.Overall,we believe that the update and implementation of future guidelines can further help improve the emergency management level of AHF patients’s GDMT dose-titration,better improve their clinical outcomes,and enhance their quality of life.

关 键 词：急性心力衰竭 指南 治疗 急诊管理 

分 类 号：R54[医药卫生—心血管疾病]