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房间隔缺损课件_9

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房间隔缺损9
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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 ASD) 常见先天性心脏病,占先心病总 数5—10% 女性多见,女:男≈1.5—2:1 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 一、病理解剖分型 1、继发孔缺损(70%) ⑴中央型 ⑵下腔型 ⑶上腔型、 静脉窦型,常伴部份肺静脉异位 连接 2、原发孔缺损(15—20%) 常伴二尖 瓣前叶裂缺 又称部份房室隔缺损 3、完全性房室隔缺损(10—20%) 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 二、病理生理(血流动力学变化) 上下腔静脉 肺静脉 分流 右心房(血量增多) 左心房 右心室(扩大) 左心室 肺动脉(扩大) 主动脉血量减少 肺循环充血 体循环供血不足 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 分流量多少取决于: 1、缺损大小 2、左右心房间的压力阶差 3、左右心室的充盈阻力 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 三、临床表现 取决于缺损大小、分流量多少 轻者无症状 分流量大,症状出现早 体循环缺血:消瘦、乏力、多汗、气促 肺循环充血:反复呼吸道感染、心力衰竭 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 典型心脏体征 1、心前区冲动抬举感,无震颤 2、L2—3喷射性收缩期杂音(肺动脉相对 狭窄) L4—5舒张期杂音(三尖瓣相对狭窄) 3、第一心音响亮,P2亢进且固定分裂 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 四、辅助检查 1、X线胸片:肺充血,肺动脉段突出,主动 脉结缩小,右心室肥厚。外形 似梨形 2、心电图: 电轴右偏;不完全性或完全性 右束支传导阻滞; V1qR>0.03秒;右心室肥厚 原发孔缺损 电轴左偏;Ⅰ°房 室传导阻滞;左心室肥厚 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 3、超声心动图:右房右室内径增大,可显示 缺损部位和大小。多普勒 可检测分流血流的位置方响4 、心导管造影:⑴可探及房隔缺损。 ⑵右心室血氧>上下腔静脉 1.9Vol% ⑶右心室、肺动脉压力正常 或轻度增高 ⑷右肺静脉、左心房造影可 显示缺损 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 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 五、预后 自然闭合很少 儿童期很少发生严重肺动脉高压 感染性心内膜炎发生少 大分流量可引起心力衰竭 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 六、治疗 1、介入治疗 经导管堵塞缺损 双盘伞状堵塞器 Amplazer封堵器 2、外科手术 体外循环,开胸直视修补 缺损 手术年龄一般在学龄前 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 *16 •介入治疗适应证 • (1)继发孔型房间隔缺损 • (2)缺损直径>5mm,30mm • (3)缺损边缘距冠状静脉窦、上 、 • 下静脉、肺静脉>5mm,距 房 • 室瓣>7mm • (4)房间隔直径>选用封堵伞左 房 • 侧的直径 • (5)年龄>3岁 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 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 *18 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