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首页 张斯为-肺心病

张斯为-肺心病.ppt

张斯为-肺心病

一山之中
2010-07-12 0人阅读 举报 0 0 0 暂无简介

简介:本文档为《张斯为-肺心病ppt》,可适用于医药卫生领域

ChronicPulmonaryheartdiseaseDefinitionChronicPulmonaryheartdiseaseDefinitionItisdirectlycausedbychronicalterationsinpulmonarycirculationorchronicchestdiseasesthatleadtopulmonaryarterialhypertension,rightventricularenlargement,evenrightheartfailureEtiologyEtiologyABronchialandpulmonarydisorders:chronicbronchitiscomplicatedwithCOPD:-asthma,bronchiectasis,tuberculosis,silicosis,chronicinterstitiallungdiseaseBDisordersofchestmovement:(rare)abnormality,adhesion,vertebraltuberculosis、rhumatoidspondylitis。EtiologyEtiologyCDisordersofnerveandmusclePoliomyelitisdisordersofmotornervecenterDDisordersofpulmonaryvesselsHypersensitvegranulomaembolismofpulmonaryarteryEpulmonaryarterialhypertensionofunknowncausePathologyPathology)mainprimarydisordersoflungchronicbronchitisandemphysema)changesofpulmonaryvesselsAthewallofpulmonaryvesselsthickening,narrowing,orobliterativeBcapillarybedofalveolarwalldamaged,decreasedCvascularbedoflungcompressedtobeirregularPathologyPathology)changesoftheheartincreasedheartweighthypertrophyofrightventricleenlargementofrightventriclePathophysiologyandpathogenesisPathophysiologyandpathogenesisApulmonaryarterialhypertensionApulmonaryarterialhypertension)organicchangesofpulmonaryvesselsathickeningofthevesselsbdeteriorationofemphysemacDecreasedcapillarybed:>)functionalchangesofpulmonaryvesselsfactorsofbodyfluid,tissueandnerve)remodelingofpulmonaryvesselsvasoconstrictionofvesselshypertrophyofsmoothmusclecell)increasedbloodvolumeandincreasedbloodviscosityhypoxiaRBCbloodviscosityresistanceofbloodflowBChangesofrightheartfunctionBChangesofrightheartfunctionLoadofrightventricleandhypertrophyofrightventricleearlystage:compensatedacuteexacerbation:incompetencycardiacoutputCImpairmentoftheotherimportantorgansCImpairmentoftheotherimportantorgansBrain,liver,kidneydigestivecanal,etalClinicfindingsClinicfindings)compensatedstage(includeremittentstage)signs:cough,sputum,wheeze,exertionaldyspnea,edemaoflowlimb,exerciseintolerancephysicalexaminationdecreasedbreathsounds,rhonchiormoistralesdistanceofthecardiacsoundP>Atheupperborderoftheliver)incompensatedstage(includeacuteexacerbation)respiratoryfailure(inducedbyinfection)heartfailureComplicationsComplications)pulmonaryencephalopathy:maincauseofdeath)imbalanceofacidandalkaline,disturbanceofelectrolytes)arrhythmia)shock:infection,bloodloss,cardiac)digestivebleeding)DICLaboratoryfindingsandotherexaminationsLaboratoryfindingsandotherexaminationsaChestXraythesignofpulmonaryarterialhypertensionthewidthofrightinferiorpulmonaryartery>mmextrudingofpulmonaryarterysegmentenlargementofrightventriclebEKGhypertrophyofrightventriclePulmonaryPwaveRvSv>mVV,,lead:Qs,VRS<cVectorcardiogramEnlargementofrightatriumandrightventricledEchocardiogramInnerdiameterofolowductofrightventricle>mmInnerdiameterofrightventricle>mmInnerdiameterofpulmonaryartery:increasedebloodgasanalysisPaCO,PaO,HCO,AB,PHnormalor,fbloodtestRBC,Hb,bloodviscosityWBC,PK,Na,Cl,Ca,MgDiagnosisDiagnosischronicbronchitis,emphysema,disordersofchestandlung,disordersofpulmonaryvessels,etalpulmonaryarterialhypertension,rightheartfailurecorrespondingsymptomsandsigns,Xray,EKG,lungfunctiontestDifferentialdiagnosisDifferentialdiagnosis)coronaryheartdiseasesanginapectoris,myocardialinfarction,hypertension,hyperlipidemia,diabetes,EKG:hypertrophyofleftventricle)rheumaticvalvularheartdiseasesRheumaticarthritis,mitralandaorticvalvulardisorders)primarycardiomyopathiesenlargementofthewholeheartwithoutchronicrespiratoryhistoryandpulmonaryarterialhypertensionTreatmentTreatmentAcontrolinfectionselecteffectiveantibioticsBfreetheairway:treathypoxiaandhypercapniaCcontrolheartfailurecontrolheartfailurecontrolheartfailure)Diuretics:milddiuretics,avoidlowKandlowCl)Digitalis:smalldosage(dose),fastexcretionandonset)vasodilators:decreasepulmonaryarterypressure,Cablocker)controlarrhythmia)strengthennursing)remittentstagerelievetheinducedfactors,exercise,Chinesemedicine,etalPrognosisPrognosislungfunctionworseningprognosismortalityrate:

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