4????42???1980?1990?2000?3????????????????,????????????????16.3%?17.9%,?????56.7%,?????63

1
??????????????
------?????????????2010

• ????????????
• ???

2
????????????????

• 1????????????,??????,???????????????????????????,?
  ????????
• 2????????????,??????,????????????????????????????
  ?,?????????????????????????,????????????????????

3
?????????????2010?

• 1.??
• 2.???????????
• 3.???????????
• 4.???????????????
• 5.????????????

4
?????????
1?????10??,????????????1000????????????15?20????
?,????????????? 2???????????0.23?0.27?????????,?
?????3,3??5????????30?60? 3???????????????12,1
?????30?
5
?????????

• 4????42???1980?1990?2000?3????????????????,???
  ?????????????16.3?17.9,?????56.7,?????6367???
  ??????????????????????
• ??20????,???????????36.8?8.0??45.6?12.9,??
  ???????34.4??18.6????????????(42.543.7)?????
  ?????????????

6
??

• ?? ?????????????????????????????????
• ???? ?????????????????????????????
• ???? ???????????????????????????????????????????

7
???????????

• 1.????????
• 2.???????(?)??
• (1)??????????????????????????????????????
• (2)???????
• (3)??????
• (4)????????????,??????????

8
???????????

• 3.?????????
• (1)?????????(?)????????,???????????????(?)????????
  ?????(?)????????????????
• (2)?????
• (3)????????????
• (4)?????
• (5)????
• (6)?????????,????????????????(???)

9
??????????????
1?????(CO)??,??????????????????????,??????????????
???,???????? 2????????????????(PCWP)??,???????????
??????????
10
?????????????2010?
1.?? 2.??????????? 3.??????????? 4.?????????????
?? 5.????????????
11
???????????

1. ?????????????
2. ????
3. ??????????
4. ?????
5. ?????

12
?????????????

• ?????????,?????????
• ??? ???,????,??????????
• ??????????,??????,???????

13
????

• 1.?????????????
• 2.???????
• 3.????,????????
• 4.??????, ??????
• 5.????
• 6.????
• 7.????????
• 8.????????(??,??)
• 9.?????,???,?????,?????

14
??????????

• ??????????????,????
• ?????,???????,?????????
• ???????,??????,??????.

15
?????

• ?????????????
• ??????,????,????????,RR30-50?/?
• ??,?????????
• ?????,?????????,???????????

16
?????

• CO??????????????
• ??????, ?????90mmHg??,?????????????60mmHg??
• ????????????????????????????????,????,????????
  ???????, PCWP?, CI????????????

17
???????????????
l???? Q? 2???x??? ?????? 3??????
EF???? 4??????? ???? ??? 5???????? TNT?
?????? 6.?????? BNP??????
18
????? BNP
B ????(BNP)?N??B?????(NT-proBNP) ?????????????????
????????? ?????BNPlt100ng/L?NT-proBNPlt
400ng/L ?????BNPgt400ng/LNT-proBNP gt 1500ng/L
????????????????????
19
????????????
???Killip?(?1) Forrester?(?2) ???????(?3)??
20
Killip???
21
Forrester???
22
??????
23
???????????
24
?????????????2010?
1.?? 2.??????????? 3.??????????? 4.?????????????
?? 5.????????????
25
?????????
1.???????????????? 2.???????????????? 3.
?????????,?????90mmHg,????????
4.??????,??????????
26
????????
27
???????????
1?????????????????????,???????????,??????? 2???
3??? ???? 4?????? ????,??????????
,??gt??5001000ml/d?
28
???????????
1.?????(?a?,C?) 2.??????(?a?,C?) 3.???(I?,B?) 4.?
???? 5.??????
29
???

• ?????????
• ?????????????????
• (1)???????????????
• (2)??????????

30
?????
?????????????????????????????????????
???gt110mmHg??????????????? ????90110mmHg?????
????? ???lt90mmHg?????????

31
?????
????? ?? ?? ??? ??
???? I? B? ???/?? BPgt90mmHg ??10-20µg/min ??200µg/min ??? ?? ???? ?????
???????? ???/?? BPgt90mmHg ??1mg/h ??10mg/h ??? ?? ???? ?????
??? ???C? ????????/??, BPgt90mmHg 0.3-5µg/kg/min ??? ????? ?????
rhBNP ?a?? B? ???/?? BPgt90mmHg ??2µg/kg ??0.015-0.03µg/kg/min ???  
32
?????
rhBNP(???) ????????,??BNP???????????
?????????(??????),?????????,???????????????CO,????
??????????????????????,???????????????????????,??
??????????RAAS???????,??????????????????????(VMAC
?PROACTION)??,????????????????????,???????????????
??????????,rhBNP???????????????PCWP,??????????
33
?????????????

• 1.???lt90mmHg,?????????????????????,???????????
• 2.????????????,????????,???????????????????????,?
  ????CO????
• 3.??????????

34
??????
???????????????,?????????????,?????????
??????????????????????????????????.
?????????????,??????????.???????????
35
????(?a?,C?)

• ?????????CO??????????????????????????
  ????????C 0.2-0.4mg??????,24h?????0.2mg,?????????
  ????????????

36
???(?a?,C?)
?? ???? ???? ?? ??? ???
??? ????? ????????? lt3µg/(kgmin) lt3µg/(kgmin) 2-3µg/(kgmin)??AHF???????
??? ??? ???????(??) 3-5µg/(kgmin) 3-5µg/(kgmin) 2-3µg/(kgmin)??AHF???????
??? ?? ??? ????(??) gt5µg/(kgmin) gt5µg/(kgmin)
37
?????(?a?,C?)
?? ???? ???? ?? ???
????? ?1?? ?2?? ????? ???????, ???????? ???????? 2-20µg/(kgmin) ???????(?????????)???????????,???????????????
38
????????(?b?,C?)
???????? ???? ???25µg/kg,???,16-20?
?????,??0.375-0.75µg/kg/min??????? ????
??????,??????? ???? ????????,????????,???
?????
39
????(?a?,B?)
????----???? (1)??????????C???,???????????,?????
??????,???????? (2)?????,?????????ATP?????,???????
????,????????????????????????
40
????

• ????VS?????????
• ???????????
• ??????????
• ??????????????,
• ?????????
• ????????

41
???????????????????
?????????????????? (1)?????????l?2????????,??????
????,???????????? (2)??????????????,?????????(?)?
????????????
41
42
???????????????????

• (3)?????????????????????????,????????
• (4)?????????????????????????,?????????????????????
  ,??????????????
• (5)????????????????????????

43
??????????

• 1.IABP(I? B?)????????????????????????CO?????
• 2.??????????????????????????????????????????????
  ??.
• 3.??????(?a?,B?)???,????????,????,??????????????
  ?????????????????????????????????
• 4.????????(?a?,B?)????????(ECMO),?????,??????????
  ???

44
????????

• ????????????,?????(??,??,???,???????),??????
• ??????????????????,????????????????????????????,??
  ????????
• ?????????????????????????????,???????????
• BNP/NT-proBNP???????????????
• ????????????,?????????

45
?????????????2010?
1.?? 2.??????????? 3.??????????? 4.?????????????
?? 5.????????????
46
??????????????
??????????????? ???????????? ????????????? ???????
?????????
47
?????????????
(1)???????? (2)??????????? (3)??????? (4)?????
???????????? ??????????????????????????ß????? (5)
??ST?????????,??????????, ????????????????
48
??????????

• ???gt180/120mmHg,X???????
• ??1 h?????????????25,26 h??160/100110mmHg,
  2448 h??????????
• ??????????,???????????????????????????????????
  ??????????????????????????????????

49
???????????

• ?????????????????????????????
• ????????????????,????
• ???????????????????????

50
??????????????

• ??????,?????????,??????????????
• 1. ???????????????,????????????????????????????
  ?
• 2. ????????????????????,?????,?????????
• 3. ????????????,??????,??????
• 4. ??????,??,VC,???.

51
?????????????2010?
1.?? 2.??????????? 3.??????????? 4.?????????????
?? 5.????????????
52
????????????

• ???????????????????????,???????????????
  ??????????????????????????AVB?
• ??????????????,???????????????,?????????????
  ???????????,???????????????,???????????????????

53
????????????

• 
  
  ???????,??????,?????????,??????????????,??????(I??
  C?)
• ?????????????????????,?????????????????(?a??C?
  )
• ??????????????????,?????????C????(I??B?)???
  ????????,????????(1020min)???150300
  mg(I??B?),????????,?????,????????????????????
• ????????????ß??????????

54
????????????

• ??????????,????????,??????,??????,?????????
  ???????????????,????????,??????????,???????,??????
  ???,??????????,?????????????150
  mg(10min)?????1mg/min x6 h,??0.5 mg/min18
  h(I??c?)???????????????????

55
????????????

• ???????????,????????????,??????????????????
  ?????????????,???AVB???2?AVB?????????????

56
??

• ?????????,????,??????????,?????

57
??!