cvd心衰超濾

Ⅰ 我是一個擴張性心肌病患者現在腹水嚴重，以出現耐葯性，聽說有一種超濾技術是針對心衰患者腹水的

一個擴張性心肌病患者，現在復出嚴重出現，那有新聽說有個超力計數法，我覺得你要先去了解一下再說

Ⅱ 心衰時無尿或嚴重少尿如何處理

我們一個心衰的病人出現以上情況．速尿用到了200mgQd，用到第二天患者尿量達到2000ml／天，在未使用的情況下，尿量為700ml／天，不過用的時候要密切關注患者的電解質情況，以免尿出來了而出現低鉀的情況．每個病人各有各的情況，應酌情考慮葯物的用量．僅供參考．
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Ⅲ 心血管的英文論文以及翻譯

Chronic kidney disease is a risk factor for cardiovascular disease

Chronic kidney disease (CKD) is a widespread concern of public health, the incidence increased graally, at the same time brought about serious consequences and problems. We note that the patient's renal failure is dialysis and kidney transplantation, but few scholars concerned about CKD and cardiovascular disease (CVD) relationship. Now that CKD with CVD-related, and progress than acute renal failure more likely die of cardiovascular disease, CVD is the most common CKD the cause of death [1]. Recognized that CKD is a risk factor for CVD that is very important. Only in this way will it be possible to conct an in-depth, and then search for the prevention and treatment of related measures to ensure greater benefits for these patients.
CKD is defined as biopsy or the markers of renal damage confirmed> 3 months, or GFR <60ml / (min.1.73m2)> 3 months. Cause of disease and the general based on credits for the diabetic and non-diabetic renal disease and transplantation. Renal dysfunction by renal biopsy or related markers such as proteinuria, abnormal urinary sediment, abnormal imaging to diagnose and so on. Proteinuria is not only to prove the existence of CKD, renal disease may also become an important basis for the type of diagnosis and the severity of kidney disease and cardiovascular disease-related. Urinary albumin and creatinine ratio or total protein and creatinine ratio can be used to assess proteinuria. GFR <60ml / (min.1.73m2) renal damage as a critical value, which indicates the level of GFR is often the beginning of renal failure, including increased incidence of cardiovascular disease and the degree of risk. GFR <15ml / (min.1.73m2) will need dialysis treatment.

GKD especially terminal kidney disease (ESRD) patients, CVD risk of a marked increase in general through the vascular tree to achieve. ESRD with atherosclerosis may be a causal relationship to each other, on the one hand, accelerated atherosclerosis in kidney disease progress, on the other hand, ESRD is the deterioration of many of the traditional atherosclerotic risk factors [2]. In general, CVD is the basic types of vascular disease and cardiomyopathy, the two subtypes of vascular disease is atherosclerosis and vascular remodeling, and CKD are the role of these two subtypes. Atherosclerotic plaque formation and the main obstruction in the main, CKD in atherosclerosis and the high incidence of a much wider range of diffuse atherosclerosis in a marked increase in cardiovascular disease mortality and accelerated deterioration of renal function. Atherosclerosis can lead to arterial wall thickening and myocardial ischemia matrix. In CKD patients, ischemic heart disease such as angina, myocardial infarction and sudden death, and cerebrovascular disease, peripheral vascular disease and heart failure are more common. Initially that the dialysis patients may be secondary to ischemic heart disease in easy to overload, left ventricular hypertrophy and small artery disease, resulting in reced oxygen supply. However, studies have found that EPO in the former region, the low level of hemoglobin that also may be associated with ischemia-related. CKD patients the incidence of major vascular remodeling is higher, can lead to vascular remodeling in pressure overload, through the wall and the cavity wall thickening and increased the ratio of traffic overload, or to achieve, but mainly to increase the diameter and the wall thickness of main. Vascular remodeling in arterial compliance often dropped, resulting in increased systolic blood pressure, pulse pressure increased, left ventricular hypertrophy and reced coronary perfusion [3,4]. Decreased arterial compliance and increased pulse pressure in dialysis patients are cardiovascular disease (CVD) risk factors independent [5].水鈉瀦留period as a result of dialysis treatment by ultrafiltration, dialysis patients with the diagnosis of heart failure more difficult, but the decline in blood pressure, fatigue, loss of appetite and other signs of heart failure diagnosis can be used as an important clue; On the other hand, more水鈉瀦留inappropriate to reflect the ultrafiltration rather than heart failure or heart failure combined ultrafiltration inappropriate. In fact, ring dialysis ultrafiltration is inappropriate for one of the reasons why high blood pressure, heart failure often prompts. Therefore, dialysis patients with heart failure is an important indicator of poor prognosis, which often prompts the patient is in progress of cardiovascular disease.

1 chronic kidney disease risk factors of cardiovascular disease

Is well known that patients suffering from kidney disease increase in cardiovascular disease mortality, largely attributable to high blood pressure caused by kidney disease, dyslipidemia, and anemia, but may lead to the causes of plaque rupture is not clear. Light to moderate CKD patients significantly increased the risk of vascular events, and when GFR <45ml / (min.1.73m2) at the risk greater. Recent studies suggest that e to ACEI (such as captopril, etc.) can rece chronic kidney disease patients after myocardial infarction risk, if there is no clear contraindication, it is recommended conventional [6]. In normal circumstances, the application of chronic kidney disease treatment of ACEI or ARBs should be careful, it is necessary to understand the benefits of the application, but also take into account blood pressure, renal function, blood electrolyte changes, and possible interactions between drugs, such as the decline in renal function occur, increased serum potassium, etc. must be stopped [1].

In CKD in CVD risk factors to be divided into two types of traditional and non-traditional, traditional risk factors are the main means used to assess symptoms of ischemic heart disease factors such as age, diabetes, systolic blood pressure, left ventricular hypertrophy, and low HDL - C and so on, these factors and the relationship between cardiovascular disease and most people are the same.

And define the non-traditional risk factors need to meet the following conditions: (1) to promote the development of CVD rationality biology; (2) the risk factors increased with the severity of kidney disease-related evidence; (3) reveals the CKD and the risk of CVD factors relevant evidence; (4) risk factors in the control group after treatment to rece CVD evidence. Has been identified in non-traditional risk factors are mainly Hyperhomocysteinemia, oxidative stress, abnormal lipid levels, and atherosclerosis-related increase in markers of inflammation [7]. Recent study found that dialysis patients with oxidative stress and inflammatory markers significantly higher than the general population. Oxidative stress and inflammation may become the basic medium, while other factors such as anemia and cardiac disease, and calcium and phosphorus metabolic abnormalities and vascular remodeling and a decline in vascular compliance.

1.1 Failure cardiovascular disease

CVD mortality in dialysis patients than the general population 10 to 30 times, and the emergence of heart failure after acute myocardial infarction and high mortality rates, myocardial infarction within 1 to 2 years up to 59% mortality ~ 73%, significantly higher than the general crowd, and the Worcester heart Attack Study found that 3 / 4 males and 2 / 3 of women suffering from acute myocardial infarction in diabetic patients still alive after 2 years. At the same time hemodialysis patients atherosclerosis, heart failure and left ventricular hypertrophy abnormally high incidence of nearly 40% of the patients of ischemic heart disease or heart failure.

1.2 Cardiovascular disease after renal transplantation

Renal transplant patients, 35% ~ 50% of CVD death, CVD mortality than the general population of high 2-fold, but was significantly lower than that in hemodialysis patients. The most likely reason is acceptable from a kidney transplant and dialysis-related hemodynamic abnormalities and abnormal toxins. CVD after renal transplantation is the multiple risk factors, and not only include traditional factors such as hypertension, diabetes, hyperlipidemia, left ventricular hypertrophy, and have a decline in GFR of the non-traditional factors such as hyperhomocysteinemia, as well as immune suppression and exclusion.

1.3 of cardiovascular disease in diabetic nephropathy

Early diabetic nephropathy is mainly expressed in microalbuminuria, and progression of cardiovascular disease. Although type 1 diabetes patients with normal blood pressure, but was found in 24h at night to monitor the existence of "Nondipping" mode, may lead to microalbuminuria. "Nondipping" is identified the risk factors of cardiovascular disease, microalbuminuria with the diabetic patients are more vulnerable to dyslipidemia, blood glucose and blood pressure difficult to control. The study has confirmed that microalbuminuria with CVD have a clear relationship between the two types of diabetes in both the presence, but because of the age factor in type 2 diabetes in the more significant. Microalbuminuria is now considered that the prognosis of diabetic patients with cardiovascular disease and other factors in the risk of death indicators point of view can be explained as follows: (1) traditional microalbuminuria indivial a higher incidence of risk factors; (2) micro - proteinuria can reflect the endothelial dysfunction, increased vascular permeability, abnormal coagulation and fibrinolysis system; (3) and inflammatory markers related; (4) are more vulnerable to end-organ damage. Prior studies suggest that the recent high blood pressure and vascular endothelial dysfunction, and therefore these patients may further aggravate the endothelial damage. However, the mechanism is not entirely clear at present that may be related to L-arginine transport by endothelial cells to damage, which led to the cell matrix of the lack of NO synthesis.

1.4 Non-diabetic renal disease cardiovascular disease

We mainly albuminuria and decreased GFR as a sign of chronic kidney disease, proteinuria than at the same time that microalbuminuria is more important, because whether or not there is diabetes, nephrotic syndrome and cardiovascular disease are related to the existence of the abnormal changes, such as serious hyperlipidemia and high blood coagulation status, etc. This explains the importance of recing proteinuria. At present, we risk groups were divided into 3 groups, has been suffering from CVD, other vascular disease or diabetes as a high-risk groups; with traditional CVD risk factors such as high blood pressure, age, etc., as the crowd in danger; the community known as the low-risk group members

翻譯.. 慢性腎病是心血管疾病的危險因素

慢性腎病（CKD）是值得廣泛關注的公共健康，發病率逐漸上升，同時帶來了嚴重的後果和問題。我們注意到腎衰病人的主要是透析和腎移植，但是很少有學者關注CKD與心血管疾病（CVD）的關系。現已認為CKD也與CVD有關，且比急性進展中的腎功能衰竭更容易死於心血管疾病，CVD是 CKD最常見的死亡原因〔1〕。認識到CKD是CVD的高危因素這一點，是很重要的。只有這樣，才有可能進行深入，進而尋求相關的預防和治療措施，使這些病人獲得更大益處。
CKD是指由腎活檢或有關的標志物證實的腎功損害＞3個月，或GFR＜60ml/（min.1.73m2）＞3個月。一般依據病和病因學分為糖尿病性、非糖尿病性和移植後腎病。腎功能損害可通過腎活檢或相關的標志物如蛋白尿、異常尿沉積物、影像學異常等來診斷。蛋白尿不僅可以證明CKD的存在，亦可成為腎病類型診斷的重要依據，並與腎臟疾病的嚴重程度和心血管疾病的有關。尿白蛋白與肌酐比率或總蛋白與肌酐比率可用於評估蛋白尿。GFR＜60ml/（min.1.73m2）作為腎功損害的臨界值，該水平GFR往往預示腎衰的開始，其中也包括增加心血管疾病的發生及危險程度。GFR＜15ml/（min.1.73m2）則需要透析治療。

GKD尤其是終末腎病（ESRD）患者，CVD危險明顯增加，一般通過血管樹來實現的。ESRD與動脈粥樣硬化可能互為因果關系，一方面粥樣硬化加速腎病進展，另一方面ESRD惡化是許多傳統粥樣硬化的危險因素〔2〕。一般而言，CVD的基本類型是血管疾病和心肌病，血管疾病的兩種亞型是動脈粥樣硬化和大血管重塑，而CKD對這兩種亞型均有作用。動脈粥樣硬化主要以斑塊形成和閉塞為主，CKD中動脈粥樣硬化發生率很高而且范圍更廣，彌漫的粥樣硬化明顯增加心血管疾病死亡率和加速腎功能惡化。動脈粥樣硬化可導致動脈壁基質增厚和心肌缺血。在CKD病人中，缺血性心臟病如心絞痛、心梗和猝死，以及腦血管疾病、外周血管疾病和心衰都是比較常見的。最初認為透析病人出現缺血性心臟病可能繼發於容易超載、左室肥厚和小動脈病變，導致氧供減少。但是後來的研究發現，在前促紅素區域，血紅蛋白水平低，說明亦可能與缺血有關。CKD病人大血管重塑發生率亦較高，血管重塑可導致壓力超載，通過管壁增厚和管壁與內腔比值增高或者流量超載來實現，但主要以增加的管壁直徑和厚度為主。血管重塑常常使動脈順應性下降，導致收縮壓增加、脈壓增大、左室肥厚和冠脈灌注減少〔3，4〕。動脈順應性下降和脈壓增大均為透析病人心血管疾病（CVD）的獨立危險因素〔5〕。由於透析期間水鈉瀦留可通過超濾得到治療，透析病人心衰的診斷比較困難，但血壓下降、疲勞、食慾減退等徵象，可作為心衰診斷的重要線索；另一方面，水鈉瀦留更能反映超濾不合適，而不是心衰或心衰合並超濾不恰當。實際上，透析期間超濾不合適的原因之一就是高血壓，往往提示心衰。因此，心衰是透析病人預後不良的重要指標，這往往提示病人心血管疾病正在進展。

1 慢性腎病的心血管疾病危險因素

眾所周知，患腎臟疾病的病人心血管病死亡率增加，很大程度上歸因於腎病所致的高血壓、血脂異常和貧血，但可能導致粥樣斑塊破裂的原因還不是很清楚。輕到中度CKD病人血管事件危險明顯增高，而當GFR＜45ml/（min.1.73m2）時這種危險更大。近期有關研究認為因 ACEI（如卡托普利等）可降低慢性腎病病人心梗後的危險，如沒有明顯禁忌證，建議常規〔6〕。而在一般情況下，慢性腎病應用ACEI或ARBs治療要慎重，既要了解應用的益處，又要考慮到血壓、腎功能、血電解質變化和可能的葯物間相互作用，如出現腎功能下降、血鉀增高等就必須停葯〔1〕。

在CKD中把CVD的危險因素分為傳統和非傳統兩種，傳統的危險因素主要指用於評估有症狀缺血性心臟病的因素，如年齡、糖尿病、收縮性高血壓、左室肥厚、低HDL-C等，這些因素與心血管疾病的關系與一般人是一致的。

而界定非傳統危險因素需要滿足如下條件：（1）促進CVD發展的生物學方面的合理性；（2）危險因素升高與腎病嚴重程度相關的證據；（3）揭示CKD中CVD與危險因素關系的相關證據；（4）有對照組中危險因素經治療後CVD降低的證據。目前已確定的非傳統危險因素主要有高同型半胱氨酸血症、氧化應激、異常脂血症、與粥樣硬化有關的增高的炎症標志物〔7〕。近來研究發現，透析病人氧化應激和炎症標志物水平明顯高於一般人群。氧化應激和炎症有可能成為基本的介質，而其他因素如貧血與心肌病有關，鈣磷代謝異常與血管重塑和血管順應性下降有關。

1.1 腎衰中心血管疾病

透析病人中CVD死亡率比普通人群高10～30倍，而出現急性心梗和心衰後致死率很高，心梗後1～2年死亡率達59%～73%，明顯高於一般人群，而Worcester heart Attack研究發現，有3/4男性和2/3女性糖尿病病人患急性心梗後仍存活2年以上。同時血液透析病人動脈粥樣硬化、心衰和左室肥厚發生率異常增高，有接近40%的病人出現缺血性心臟病或心衰。

1.2 腎移植後心血管疾病

腎移植病人中有35%～50%因CVD死亡，CVD死亡率比普通人群高2倍，但明顯低於血液透析病人。最可能的原因是接受腎移植後免除了與透析有關的血流動力學異常和毒素異常。腎移植後CVD的危險因素是多重的，既包括傳統因素如高血壓、糖尿病、高脂血症、左室肥厚，亦有與GFR 下降有關的非傳統因素如高同型半胱氨酸血症以及免疫抑制和排斥。

1.3 糖尿病腎病的心血管疾病

糖尿病腎病的早期主要表現為微量白蛋白尿，與心血管疾病進展有關。盡管1型糖尿病病人血壓正常，但在24h監測中發現夜間存在 「Nondipping」模式，可能導致微量白蛋白尿。「Nondipping」是已確認的心血管疾病的危險因素，伴有微量白蛋白尿的糖尿病病人也更易出現血脂異常、血糖難以控制和血壓升高。有關研究已證實微量白蛋白尿與CVD有明確關系，在兩種類型糖尿病中均存在，但由於年齡因素在2型糖尿病中更顯著。現已認為微量白蛋白尿是糖尿病病人心血管疾病預後和其他致死因素的危險指標，可通過如下觀點來解釋：（1）微量白蛋白尿個體傳統危險因素發生率更高；（2）微量白蛋白尿能反映內皮功能異常、血管滲透性增加、凝血纖溶系統異常；（3）與炎症標志物有關；（4）更易出現終末器官損害。最近Prior研究認為高血壓與血管內皮功能異常有關，因此在這類病人中可能進一步加重內皮損害。但有關機制不完全清楚，目前認為可能與L-精氨酸轉運至內皮細胞受到損害有關，進而導致細胞內合成NO的基質缺乏。

1.4 非糖尿病性腎病的心血管疾病

我們主要把蛋白尿和GFR下降作為慢性腎病的標志，同時認為蛋白尿比微量白蛋白尿更重要，因為無論是否存在糖尿病，腎病綜合征均存在與心血管疾病有關的異常改變，如嚴重高脂血症和高凝血狀態等，這就說明降低蛋白尿具有重要意義。目前我們把危險人群分為3組，已經患CVD、其他血管病或糖尿病作為高危人群；具有CVD傳統的易患因素如高血壓、年齡等作為中危人群；將社區人員稱為低危人群

Ⅳ 心衰應該如何治

心力衰竭的治療包括以下幾個方面：
1、尋找病因，對因治療，常見病因包括冠版心病、高血壓等權；
2、減輕心臟前後負荷，加強心肌收縮力，可以緩解心衰症狀；
3、使用保護心肌的葯物，挽救心臟功能，提高患者的運動耐量；
4、中醫認為心力衰竭屬於本虛標實，屬於浮腫、喘症范疇，常用扶正祛邪、溫陽利水、溫腎陽、化氣行水的方子。所謂心衰就是心臟快沒有力氣了，快不能幹活了。所以現在要在控制高血壓，糖尿病的基礎上，改善心功能，減少心臟的負荷，盡量改善症狀。

Ⅳ 慢性腎病與心力衰竭有什麼關系

在過去的十年，醫學界已公認慢性腎臟病(CKD)是心血管疾病(CVD)獨立的預測因子。統計數據顯示，CKD患者合並心血管疾病佔63％，而無CKD患者心血管疾病發生率僅為5.8％，且心血管疾病的發生率與CKD的嚴重程度呈正相關。終末期腎衰竭(ESRD)患者心源性死亡的風險是普通人群10～20倍。
心力衰竭是各種心臟結構或功能性疾病導致心室充盈及(或)射血能力受損而引起的一組綜合征，臨床表現主要是呼吸困難和無力而致體力活動受限。也常有肺淤血、下肢水腫（或體重增加）等液體瀦留現象。
因腎病也常有液體瀦留現象，腎病患者常常會忽視對心衰的診治。所以腎病患者若出現液體瀦留的現象，建議到腎內科做腎臟相關檢查的同時也到心內科做心臟方面的檢查。早發現，可以早些進行診治，延長生命。

Ⅵ 心衰如何治療

心衰是各種心臟疾病發展的終末階段，我們的心臟就像一個一直在工作的「血泵」，不停的把血液輸送到全身，當心臟疾病導致心臟受到損害時，泵血的功能就會下降，輸出的血量就不能滿足身體器官和組織的需要，就會產生心衰。
心衰會對心臟這個重要的「機器」產生磨損，產生一系列我們不希望看到的後果。首先就是心衰的各種症狀會影響日常的生活，常見的是呼吸困難，開始可能只是活動時出現，病情加重時就連睡覺或休息時也會呼吸困難，給患者帶來很大的痛苦；其次，心衰可能造成多種並發症，比如心律失常、呼吸道感染、血栓、肺栓塞、中風、腎功能衰竭、消化系統疾病等。需要引起重視的是，如果任由疾病發展，心臟可能會罷工，這時候就會產生最大的危害——猝死。
我們都知道，當機器老化時，及時採取一些保護措施會使它的使用時間更長一些，這個道理同樣適用於心衰，也就是說，心衰是可以進行治療的。盡管發生心衰時，心功能分級隨時間趨於加重，但大部分患者症狀並不是持續性惡化，葯物治療和飲食變化在心室功能無顯著變化的情況下能明顯改善或加重運動耐量。
早期主要是針對心衰危險因素進行治療，比如控制高血壓、血脂、血糖、肥胖，戒煙限酒，避免對心臟有毒性的葯物，可以適當應用ACEI或ARB等葯物；隨著心衰的進展需要增加葯物的種類，比如β受體阻滯劑、利尿劑、醛固酮受體阻滯劑、地高辛、伊伐布雷定等，嚴重者可能需要植入除顫儀、心臟移植、超濾等治療措施。

Ⅶ 腹膜透析患者剛剛開始透析，不太明白超濾量怎麼算，比如我中午灌入1330毫升，晚上流出1300毫升

腹膜透析超濾量來是透出量減去透入量源。因為沒有描述透入量，不能准確算出超濾量。一般常規透入量是2000ml，故超濾量是500ml。

以慢性腎衰竭的患者為例。如果患者有腹膜透析適應證，沒有禁忌證，則可以選擇腹膜透析治療。專科醫生將向患者或監護人無偏見地介紹血液透析、腹膜透析、腎移植等腎臟替代治療方法的治療方式、原理和各自的優缺點並給予中肯的治療建議。除醫療方面原因外，可由患者自主選擇透析方式。

(7)cvd心衰超濾擴展閱讀

需要接受透析治療的情況：

透析療法是利用半滲透膜來去除血液中的代謝廢物和多餘水分並維持酸鹼平衡的一種治療方法。

一般來說，患者血肌酐濃度超過700，或者腎小球濾過率在15ml/min/1.73m2以下時，如果出現了水負荷過重（比如有水腫或腹脹的症狀）、嚴重的營養不良、葯物難以糾正的高鉀血症、高磷血症等，就需要做好隨時做透析的准備。

Ⅷ 請問腎衰竭心衰竭做了透析後小便還是不怎麼排的出來

透析已經幫你超濾出了體內多餘的水分，沒有小便是因為你的腎功能沒有恢復。

Ⅸ 心衰病人搶救一次大概需要多少錢

患者如果有基抄礎的心臟襲疾病，比如冠心病、高血壓、心臟病，如果在出現心力衰竭的時候，應該立馬呼叫120。然後讓患者坐起來，雙下肢下垂，這樣可以減少靜脈迴流，減輕心臟負荷。有條件的給患者吸氧，然後讓醫務人員到達現場，應該立即給患者吸氧，盡量給高流量的鼻導管給氧。對於嚴重的患者，可給予呼吸機加壓給氧，然後鎮靜。葯物可以給鎮靜，給予嗎啡5-10mg肌注或者靜脈緩慢推注，以減少躁動帶來的額外的心臟負擔，可以給予強心葯物。葯物治療可以給予利尿，主要給予呋塞米靜脈推注。這個葯物除了有利尿的作用，還有利於肺水腫的緩解。還需要用血管擴張劑，血壓高的病人可以硝普鈉、硝酸甘油靜脈滴注。心力衰竭的病人，心臟的收縮力是降低的，給予強心葯物，比如洋地黃類的葯物等等，心力衰竭還可以合並支氣管痙攣，然後靜脈給予二羥丙茶鹼或者滴注氨茶鹼等葯物。氨茶鹼可以解除支氣管痙攣，並且還有一定的強心作用、利尿作用，可以起到輔助治療效果。然後還可以靜脈推注激素，比如地塞米松，可以減輕肺水腫。
心力衰竭多少費用，這是不能確定的，你可以到當地的正規醫院問問。

Ⅹ 心衰引起腳腫、腿腫該怎麼治療

作為一個醫來生，我不會對自你說假話。你母親現在病情已經到後期了，也就是說的心衰很嚴重，心功能很差非常差。他可能動動就氣短，胸悶。這個時候真的已經沒有什麼好的辦法了，這類病人每次重了就來醫院。醫生唯一能做的就是用大劑量的利尿劑來減輕心功能符合，然後就是保證她的電解質不紊亂。
給你說幾個注意事項吧。 注意千萬不要讓她勞累，情緒不能激動，堅持服葯，不要老是下地走路，下肢如果經常下垂，心功能不好血回抽不會去就容易腫的跟麵包一樣。 如果實在不行就去住院，如果醫生不收就告他。···治病是醫生的天職