87.急性失償性心衰(acute decompensated heart failure)為加護病房中常見合併症及困難處理之心臟問題,請問有關診斷及處置何者錯誤?
(A)急性心衰竭可分為收縮性及舒張性心衰竭,前者之左心室收縮力下降而後者正常,兩者之心臟舒張末壓力皆>16mmHg
(B)對於 high pulmonary artery wedge pressure/low cardiac output/high systemicvascular resistance/high blood pressure 之左心室衰竭患者,可以優先使用血管舒張劑如nitroglycerin,如有體液過多或持續PAWP>20mmHg可以加上利尿劑使用
(C)對於high pulmonary artery wedge pressure/low cardiac output/normal systemicvascular resistance/normal blood pressure 之左心室衰竭患者,除了考慮用血管舒張劑外,可以考虑加上增強心臓收縮藥物如 dobutamine,milrinone orlevosimendan
(D)對於 high pulmonary artery wedge pressure/low cardiac output/high systemicvascular resistance/low blood pressure 之左心室衰竭患者,除了考慮用血管舒張劑外,可以考慮加上利尿劑使用以減少心之前負荷preload