本文選題：心衰 + 貧血��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：心力衰竭是各種心臟疾病的嚴(yán)重和終末階段,引起患者生活質(zhì)量降低,發(fā)病率高、死亡率高。心衰常合并多種合并癥,如貧血、鐵缺乏、腎功能不全、慢性肺部疾病、睡眠呼吸疾病等,影響患者生活質(zhì)量及預(yù)后。貧血是心衰常見合并癥,不同研究顯示的貧血發(fā)生率在4%-70%之間。貧血的原因是復(fù)雜且多重的,常見缺鐵、血液稀釋、促紅細(xì)胞生成素的產(chǎn)生和功能異常等。以及其他引起貧血的原因如骨髓增生異常綜合征、化療引起等,均會影響患者的預(yù)后。貧血引起心衰患者心功能降低、住院周期延長,再住院率增加,死亡率增加。來自阜外醫(yī)院心衰中心的一項回顧性研究,共納入2010年至2014年間在北京阜外醫(yī)院心力衰竭中心主因心衰住院的患者,研究結(jié)果顯示在1528例心衰患者中,貧血發(fā)生率為25.7%。Kaplane Meier生存曲線顯示合并貧血者較非貧血者比,住院期間全因死亡風(fēng)險增加。貧血的治療應(yīng)基于其發(fā)生的病理生理學(xué)機制,才能有效提高血紅蛋白水平、組織器官的氧合,甚至預(yù)后。在血紅蛋白水平顯著降低的患者中,可根據(jù)輸血指南建議短期內(nèi)靜脈輸血迅速提高血紅蛋白水平。鐵劑的補充、促紅細(xì)胞生成素的使用為心衰治療常用方法。其中鐵缺乏在心衰患者中的發(fā)生率為30%-60%,鐵缺乏可引起缺鐵性貧血,同時在不引起患者貧血的情況下骨骼肌功能障礙,影響心衰患者運動耐力及預(yù)后。心衰患者缺鐵可分為絕對缺鐵和功能性缺鐵,兩者產(chǎn)生的的原因不同。多項研究表明,補鐵治療可以糾正心衰患者貧血,可以提高心衰患者的6分鐘步行距離及峰值氧耗,降低死亡率改善預(yù)后。補鐵治療方式可選擇靜脈補鐵和口服補鐵。FAIR、CONFIRM研究均表明靜脈補鐵可改善心衰患者運動耐力、生活質(zhì)量,改善預(yù)后,發(fā)生致死性過敏反應(yīng)及輸液局部不良反應(yīng)少見,在2016年歐洲心衰指南中推薦合并鐵缺乏的心衰患者應(yīng)予靜脈補鐵治療(Ⅱa,A)�？诜a鐵受鐵劑吸收效果的影響,在心衰治療中的有效性仍有爭議。
[Abstract]:Heart failure is a serious and terminal stage of various heart diseases, which results in low quality of life, high morbidity and high mortality. Heart failure is often associated with multiple complications, such as anemia, iron deficiency, renal insufficiency, chronic lung disease, sleep respiratory disease and so on, affecting the quality of life and prognosis of patients. Anemia is a common complication of heart failure, with anemia rates ranging from 4 to 70% in different studies. The causes of anemia are complex and multiple, common iron deficiency, hemodilution, erythropoietin production and abnormal function. And other causes of anemia such as myelodysplastic syndrome, chemotherapy-induced, will affect the prognosis of patients. Heart function decreased, hospitalization period prolonged, rehospitalization rate increased and mortality increased in patients with heart failure caused by anemia. A retrospective study from the heart failure center of Fuwei Hospital included patients hospitalized in the heart failure center of Beijing Fuwei Hospital between 2010 and 2014. The results of the study showed that among 1528 patients with heart failure, The incidence of anemia was 25.7. Kaplane Meier survival curve showed that the incidence of anemia was higher than that of non-anemia patients, and the risk of death was increased during hospitalization. The treatment of anemia should be based on its pathophysiological mechanism in order to improve hemoglobin level, oxygenation of tissues and organs, and even prognosis. In patients with significantly reduced hemoglobin levels, short-term intravenous blood transfusion may be recommended to rapidly increase hemoglobin levels according to the transfusion guidelines. Iron supplement, erythropoietin is commonly used in the treatment of heart failure. The incidence of iron deficiency in patients with heart failure is 30-60. Iron deficiency can cause iron-deficiency anemia and skeletal muscle dysfunction without anemia affects exercise endurance and prognosis of patients with heart failure. Iron deficiency in patients with heart failure can be divided into absolute iron deficiency and functional iron deficiency, the causes of which are different. Many studies have shown that iron supplementation can correct anemia in patients with heart failure, increase 6-minute walking distance and peak oxygen consumption of patients with heart failure, and reduce mortality and improve prognosis. The methods of iron supplementation can be chosen by intravenous iron supplementation and oral iron supplementation. The study of CONFIRM shows that intravenous iron supplementation can improve exercise endurance, quality of life and prognosis of patients with heart failure. Fatal allergic reactions and local adverse reactions of transfusion are rare. In the 2016 European guidelines for Heart failure, it is recommended that patients with heart failure associated with iron deficiency should be treated with intravenous iron supplementation (鈪，

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