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房间隔缺损业务查房图文课件

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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 房间隔缺损 Atrial Septal Defect 护理业务查房护理业务查房 CCU CCU 郑斐郑斐 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 概述 房间隔缺损(ASD)为临床上常见的先天性心脏畸形, 是原始房间隔在胚胎发育过程中出现异常,致左、右心房之 间遗留孔隙,造成心房之间左右分流的先天性心脏病。 房间隔缺损可单独发 生,也可与其他类型的心血 管畸形并存,女性多见,男 女之比1:2,在成人先心病 中发病率居于首位。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 分类 原发孔 房间隔缺损 n原发孔房间隔缺 损常伴有二尖瓣和 三尖瓣的畸形。 房间隔缺损 继发孔 房间隔缺损 n继发孔房间隔缺 损根据缺损出现的 部位分为四类。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 继发孔房间隔缺损病理解剖及分型 中央型上腔型下腔型混合型 约占76%,位于 卵圆窝处。 约占3.5%,缺 损位于房间隔后 上方,上腔静脉 入口下方。 约占12%,缺损 位于房间隔后下 方,上腔静脉入 口处。 约占8.5%,两 种以上畸形同时 存在,为巨大缺 损。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病理生理 n正常左心房压力为8~10mmHg,右心房压力为3 ~ 5mmHg,因此发生ASD时的分流系为由左 右。 n分流量大小,主要取决于 缺损口的大小及两侧心房 的压力差 两侧心室的充盈阻力 肺循环的阻力 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 血流动力学改变 肺静脉 左心房 血容量减少 左心室 血容量减少 主动脉 血容量减少 体循环 供血不足 右心房 血容量增加 右心室 扩张、肥大 肺动脉 扩张 肺动脉循环 充血 ASD 分流 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 n主要取决于缺损及分流量的大小。 • 症状 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 • 体征 心脏听诊 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 诊断 辅助检查 体征 症状 病史 诊断 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 心电图 X-ray 胸片 心导管及 造影检查 MRI 超声 心动图 超声心动图 是主要的诊断方法。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 n心电图 ü心电轴右偏 ü右心房大 ü右心室容量复合增加(V1导联常呈rsR波形) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 n胸片X线 ü缺损小者可无改变 ü分流量大者主要显示为 — 心胸比例扩大 — 右心房、右心室扩大 — 肺动脉段突出,可见 肺门“舞蹈征” — 双肺血管影增多,呈 肺充血表现 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 内科治疗介入治疗手术治疗 房间隔缺损房间隔缺损 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 n内科治疗 主要针对并发症治疗,监测肺动脉压力, 指导喂养,保障发育。 肺炎心内膜炎肺动脉高压心力衰竭 控制感染 中重度时,给予 血管扩张药物。 常规洋地黄等抗心 力衰竭治疗。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 n手术治疗 ü在体外循环情况下,开胸直 视修补术; ü通过胸骨正中切口进行简单 缝合修补或者用心包补片; ü手术年龄 一般在学龄前(3-5 岁)最为理想。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 n介入治疗—适应症 根据中国先天性心脏病治疗指南,ASD的介入治疗的 适应症包括: ü年龄:通常≥3 岁或体重5Kg; ü直径≥5 mm ,伴右心容量负荷增加,≤ 36 mm 的继发孔 型左向右分流ASD; ü缺损边缘至上下腔静脉及肺静脉的距离≥5 mm;至房室瓣 ≥7 mm; ü外科手术后的残余缺损; ü不合并必须外科手术的其他心脏畸形。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治疗 n介入治疗—并发症 血栓形成及栓塞 03封堵器脱落 02急性心包填塞 01 为ASD封堵 术严重并发症之 一,多发生于术 中,因左右心房 壁被导管、导丝 、封堵器损伤穿 孔所致。 为ASD封堵术常 见并发症,多发生于 术中,很少一部分发 生于术后24h内,主 要因封堵器选择偏小 、释放时封堵器不到 位所致。 主要由于术后 抗凝治疗不够造成 ,主要发生在3个 月内,包括封堵器 血栓形成、脑栓塞 、肺栓塞等。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查辅助检查 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理诊断护理诊断 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护护 理理 措措 施施 术前护理术前护理: n1)备皮 :备皮范围脐下至大腿上1/3,两侧达腋中线。 n2)成人术前8~12h禁食水,儿童术前4~6h禁食水。 n3)在左手建立静脉通路。 n4)由于房间隔缺损封堵术是经大腿部位的股静脉进行,所 以患者最好在术前1~2日练习卧床解大、小便。 n5)术前做碘过敏试验。 n6)心理护理:鼓励病人表达自己的感受,向病人讲解心脏 的解剖及生理,房缺的知识,手术过程等。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 术后护理:术后护理: 1)术后平卧位,术侧肢体制动8-10小时,绷带加压包扎伤口 6~8小时。 2)密切观察伤口情况,注意观察有无出血,血肿,渗出。 3)密切观察病情变化,发现异常及时通知医生。 4)术后即可进食,避免进食产酸,产气食物如牛奶。 5)鼓励患者多饮水,增加肾脏排泄,以免造影剂滞留造成肾 功能的损害。 6)术后继续服用阿司匹林,告知患者和家属服用抗凝剂的重 要性。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society n n ⑴⑴心律失常:封堵术后常见的并发心律失常:封堵术后常见的并发 症为各种心律失常,多由封堵器未症为各种心律失常,多由封堵器未 完全固定,右心房搏动时刺激有关完全固定,右心房搏动时刺激有关 。因此,患者行封堵术后进行心电。因此,患者行封堵术后进行心电 监护尤为重要,心电图的变化可直监护尤为重要,心电图的变化可直 接反映术后封堵的效果。接反映术后封堵的效果。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society n n ⑵⑵出血:房间隔缺损封堵手术一般有股动出血:房间隔缺损封堵手术一般有股动 脉、股静脉伤口,嘱患者患侧肢体制动,脉、股静脉伤口,嘱患者患侧肢体制动, 卧床休息卧床休息1212小时。要经常巡视患者伤口情小时。要经常巡视患者伤口情 况,观察其足背动脉搏动情况及皮温、颜况,观察其足背动脉搏动情况及皮温、颜 色变化,防止动脉栓塞的发生。并密切观色变化,防止动脉栓塞的发生。并密切观 察伤口有无渗血、渗液,如有少量渗血要察伤口有无渗血、渗液,如有少量渗血要 及时更换敷料,如有皮下淤青要做好标记及时更换敷料,如有皮下淤青要做好标记 ,动态观察其大小,防止皮下血肿的发生,动态观察其大小,防止皮下血肿的发生 。。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society n n ⑶⑶血栓:血栓:发生率低,但后果较严重,发生率低,但后果较严重,术中及术中及 术后给予严格的肝素化及抗血小板药物治疗术后给予严格的肝素化及抗血小板药物治疗 可减少该并发症,如果发生,给予抗凝药物可减少该并发症,如果发生,给予抗凝药物 后绝大多数会消失,必要时可考虑溶栓。后绝大多数会消失,必要时可考虑溶栓。 n n ⑷⑷溶血:封堵术后要观察患者尿液的颜色、溶血:封堵术后要观察患者尿液的颜色、 有无酱油色尿液即血红蛋白尿的排出。血红有无酱油色尿液即血红蛋白尿的排出。血红 蛋白尿多由封堵术后并发症残余分流引起,蛋白尿多由封堵术后并发症残余分流引起, 因此,术后应加强对患者病情的监护,经常因此,术后应加强对患者病情的监护,经常 观察患者血常规的变化,一旦出现尿液颜色观察患者血常规的变化,一旦出现尿液颜色 的异常要及时报告医生。的异常要及时报告医生。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 出出 院院 指指 导导 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
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