top of page

什麼是心臟衰竭?

根據2020年WHO報告心臟疾病是全球十大死因之首,在香港亦是第三大死因。可見心臟健康確是不容忽視。在多種心臟疾病中,心臟衰竭可算是最需要關注的其中一種,因病徵不明顯,所以容易被忽視。心臟衰竭患者不但入院率高,而5年存活率只有約五成,比部分常見癌症如乳癌和大腸癌還要低。


何謂心臟衰竭

心臟衰竭(Heart failure) 是心血管疾病的一種。人體依靠心臟泵血,通過有規律的收縮與舒張活動,把血液輸送全身以提供身體所需的營養與氧分。而心臟衰竭是指心臟肌肉變弱,無法泵出足夠的血液來維持身體日常所需。


心臟衰竭的病徵

初期病徵相對不明顯,因為心臟會自行調節,暫時彌補心臟衰竭的影響,掩蓋病徵。但久而久之,當心臟衰竭持續惡化,心臟和身體不能再調節時,各種病徵便會浮現。

常見的病徵有:

  • 氣喘:液體或水份聚積在肺部,造成日常活動期間如走路或爬樓梯時感覺喘不過氣

  • 咳嗽:液體或水份聚積在肺部,咳出白色或粉紅色,帶泡沫的痰

  • 水腫:液體或水份聚積在腿部、腳踝或腹部,造成腫脹

  • 疲憊:肌肉和組織需要氧氣來產生能量,當含氧量較少時容易感到倦怠

  • 噁心或食慾不振:液體或水份聚積在腸道周圍,影響消化,導致沒有食慾或覺得反胃

  • 思緒混亂或思考困難:血液中某些物質(如:納)的水平出現變化

  • 心跳加快:心臟跳動加快以彌補泵血能力的不足


心臟衰竭的成因

心臟衰竭有很多成因,有由心臟疾病所引起的,如冠心病、高血壓、心臟瓣膜病或先天性心臟病等。同時也有可能由肺部疾病、睡眠窒息症、糖尿病、肥胖等其他原因引發心臟衰竭的問題。


心臟衰竭的診斷

醫生需從各方面的檢查和測試以診斷你是否患有心臟衰竭,包括:血液測試(生物標記分析)、胸部X光檢查、心電圖檢查(ECG)、心臟超音波檢查(ECHO Cardiography) 、心導管檢查及心臟磁力共振(MRI)等。


心臟衰竭的治療

治療心臟衰竭先要改變生活習慣,例如戒煙酒、維持健康體重、健康的飲食及多做運動等12,以減輕心臟的負擔。此外,透過藥物、手術及持續醫療照顧,可以紓緩病徵、延緩病情惡化及降低入院和死亡風險13。 根據美國心臟學會指導醫學治療指南建議, 心臟衰竭患者的主要藥物治療包括:

  • 腦啡肽酶抑制劑配合血管收縮素受體抑制劑 (Angiotensin receptor-neprilysin inhibitor, ARNI)

  • β受體阻滯劑 (Beta-blockers)

  • 抗鹽皮質激素 (Mineralocorticoid Receptor Antagonist)

  • 鈉-葡萄糖協同轉運蛋白2抑制劑 (SGLT2 inhibitor)

其他附加治療(按個別患者狀況):

  • 利尿藥(Diuretics)

  • 選擇性竇房結 If 抑制劑 (If current inhibitor)

嚴重心臟衰竭患者可能需要植入醫療器械或接受外科手術,治療包括:

  • 心臟再同步療法起搏器 (CRT-P)

  • 植入式心律轉復除顫器 (ICD)

  • 心臟再同步治療法除顫器 (CRT-D)

  • 冠狀動脈搭橋手術 (CABG)

  • 瓣膜修復或置換手術

  • 心臟移植

病後護理


病後,患者更不能鬆懈,要從生活習慣做起。作息定時,要有足夠的休息,同時保持心境平靜,避免過度緊張和急躁。飲食方面,也未必需要甚麼特別的心臟衰竭食療餐單,只要維持正常體重,少吃多餐、少鹽、低膽固醇,戒煙戒酒就足夠。還要遵照醫生吩咐,定時及定量服用藥物,定時覆診,以作定期檢查。







參考資料:

  1. World Health Organization (WHO) Top 10 causes of death https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death Accessed December 2020

  2. 二零一八年按主要死因、性別及年齡組別劃分的死亡數目 https://www.chp.gov.hk/tc/statistics/data/10/27/340.html

  3. Hai JJ et al. Journal of Cardiac Failure. 2016;22(8):600-608

  4. Survival Rates for Breast Cancer https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html Accessed July 2020

  5. Survival Rates for Colorectal Cancer https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html Accessed July 2020

  6. American Heart Association. What is Cardiovascular Disease? www.heart.org/HEARTORG/Support/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp#.WNt9W2996Uk Accessed July 2020

  7. American Heart Association. What is Heart Failure? www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp#.WNt-mW996Uk Accessed July 2020

  8. American Heart Association. Warning Signs of Heart Failure. www.heart.org/HEARTORG/Conditions/HeartFailure/WarningSignsforHeartFailure/Warning-Signs-of-Heart-Failure_UCM_002045_Article.jsp Accessed July 2020

  9. Keep it pumping 認識心臟衰竭的的病徵及症狀 https://www.keepitpumping.tw/about-heart-failure/recognizing-signs–symptoms/ Accessed July 2020

  10. Heart and Stroke Foundation https://www.heartandstroke.ca/-/media/pdf-files/canada/other/understand-hf-trad-chin-final.ashx Accessed July 2020

  11. American Heart Association. Common Tests for Heart Failure. www.heart.org/HEARTORG/Conditions/HeartFailure/SymptomsDiagnosisofHeartFailure/Common-Tests-for-Heart-Failure_UCM_306334_Article.jsp Accessed July 2020

  12. American Heart Association. Lifestyle Changes for Heart Failure. www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Lifestyle-Changes-for-Heart-Failure_UCM_306341_Article.jsp Accessed July 2020

  13. American Heart Association. Living with Heart Failure and Managing Advanced HF https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf Accessed July 2020

  14. McDonagh, Theresa A., et al. “2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC.” European heart journal 42.36 (2021): 3599-3726.

  15. Heidenreich, Paul A., et al. “2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Journal of the American College of Cardiology 79.17 (2022): e263-e421.

  16. https://www.healthyd.com/heartfailure/%e4%bb%80%e9%ba%bc%e6%98%af%e5%bf%83%e8%87%9f%e8%a1%b0%e7%ab%ad/

17 views0 comments

Comentários


bottom of page