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10. Диспансерний нагляд

10.1. Загальні положення.

Зважаючи на серйозний клінічний прогноз ХСН, усі такі пацієнти потребують диспансерного нагляду.

Принциповою умовою є наступність у веденні пацієнта лікарями стаціонарного та поліклінічного закладів. Основними завданнями лікаря при спостереженні пацієнта з ХСН на амбулаторному етапі є якнайдовше підтримання досягнутого у стаціонарі ефекту стабілізації клініко-гемодинамічного стану, попередження наступних госпіталізацій з приводу декомпенсації кровообігу та з інших серцево-судинних причин, сприяння досягненню пацієнтом максимально можливої тривалості життя. Це має досягатися шляхом а) регулярного контролю клінічного стану пацієнта та повноти дотримання їм рекомендацій щодо прийому ліків, способу життя, самодогляду (див. розділ 9.14) та б) корекцію, за необхідності, рекомендованої терапії з урахуванням її переносності.

Важливе значення має лікування супутніх патологічних станів (див. розд. 9.16).

10.2. Терміни клінічного огляду.

1. Після виписки з стаціонару – кожні 2 тижні впродовж 2-х місяців.

2. У наступному:

- за умови задовільного клініко-функціонального стану (NYHA I-II) – кожні 3 місяці

- при стабільно тяжкій ХСН (NYHA III-IV), якщо пацієнт не потребує стаціонарного лікування – не рідше 1 разу на місяць.

10.3. Рекомендовані при диспансерному спостереженні процедури.

1. Загально-клінічне обстеження, оцінка волемічного статусу.

2. ЕКГ, вимірювання АТ.

3. Контроль та підтримка мотивації дотримання пацієнтом рекомендацій, за необхідності їх корекція.

4. Лабораторні аналізи :

- К+, креатинін плазми через 1 тиждень, 1, 3 та 6 міс. з початку прийому ІАПФ (БРА) та/або АМР;

- інші – за рішенням лікаря з урахуванням клінічної ситуації та характеру лікування.

11. Трудова експертиза.

Хворі із ХСН клінічних стадій ІІ А, ІІ Б та ІІІ є непрацездатними.

Рішення щодо працездатності пацієнтів із СН І стадії має прийматися на індивідуальній основі з урахуванням основного захворювання, його клінічного перебігу та характеру трудової діяльності.

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Список умовних скорочень:

АГ - артеріальна гіпертензія

АК - антагоніст (и) кальцію

АКШ – аорто-коронарне шунтування

АМР - антагоністи мінералокортикоїдних рецепторів

АТ - артеріальний тиск

ББ - бета-блокатор (и)

БРА - блокатор (и) рецепторів ангіотензину ІІ

ГКМП - гіпертрофічна кардіоміопатія

ГП - гіпертрофія простати

ДКМП - дилатаційна кардіоміопатія

ЕКГ - електро­кардіо­графія

ЕКС - електрокардіостимуляція

ЕхоКГ – ехокардіографія

ІАПФ – інгібітор (и) ангіотензин-перетво­рюю­чого ферменту

ІКД - імплантований кардіовертер-дефібрилятор

ІМ - інфаркт міокарда

ІХС - ішемічна хвороба серця

КРТ - кардіоресин­хронізуюча терапія

ЛВДП та БВДП - ліво- та бівентрикулярні допоміжні пристрої

ЛКА - ліва коронарна артерія

ЛНПГ - ліва ніжка пучка Гіса

ЛШ - лівий шлуночок

МРД - магнітно­резонансне дослідження серця

НПЗЗ - неспецифічні протизапальні засоби

НУП - натрійуретичний (і) пептид (и)

ПАК - пероральні антикоагулянти

РСС - раптова серцева смерть

САТ - систолічний артеріальний тиск

СДЛШ - систолічна дисфункція лівого шлуночка

СН - серцева недостатність

ТЕГЛА - тромбоемболія гілок легеневої артерії

ТЕУ - тромбоемболічні ускладнення

ТС - трансплантація серця

ФВ - фракція викиду

ФК - функціональний (і) клас (и) за NYHA

ФП - фібриляція передсердь

ФТ - фізичні тренування

ХОЗЛ - хронічне обструктивне захворювання легень

ХСН - хронічна серцева недостатність

ЦД - цукровий діабет

ЧСС - частота серцевих скорочень

ЧШС - частота шлуночкових скорочень

ША - шлуночкова аритмія

ШКФ – швидкість клубочкової фільтрації

ШТ - шлуночкова тахікардія

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