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婴儿和儿童心力衰竭的病因和诊断

Authors
Rakesh K Singh, MD, MS
TP Singh, MD, MSc
Section Editor
John K Triedman, MD
Deputy Editor
Melanie S Kim, MD
Translators
李自普, 主任医师，教授

引言

在美国，心力衰竭(heart failure, HF)相关的住院逐渐增加，14,000例儿童因HF住院[1,2]。儿童HF患者的住院死亡率为7%-11%[2,3]。由于多种潜在的心脏病因及不同临床情况(例如，就诊时的年龄)，小儿HF的表现多种多样。

儿科HF患者的病因、临床表现、诊断和初始评估总结在此。婴儿和儿童HF的处理将单独讨论。 (参见“婴儿及儿童心力衰竭的治疗”)

定义

HF是由心室充盈或心室射血损害造成的一种临床疾病。HF是由心室泵功能障碍，或由容量(前负荷)或压力(后负荷)的超负荷引起的[1,4]。

病理生理学和病因学

小儿HF的原因可分成病理生理性类别(表 1)。这种分类有助于理解不同原因小儿HF潜在的生理学和临床表现，并指导治疗方法。 (参见“婴儿及儿童心力衰竭的治疗”)

●心室泵功能障碍−心室功能障碍导致心室收缩力降低，从而导致心室射血功能受损。心室功能障碍既可发于在出生时心脏结构正常的儿童，也可发生于先天性心脏病(congenital heart disease, CHD)患儿。具有先天性心脏病变的患儿在就诊时可伴有心室泵功能障碍，但更常见的是，他们在心脏缺损(即“耗竭的”CHD)修复手术后几年(或甚至几十年)发展为泵功能障碍和HF。 (参见下文‘心室泵功能障碍’)

                                  

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Literature review current through: 2017-07 . | This topic last updated: 2017-04-21.
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