血液循环TBL案例.docVIP

血液循环TBL案例 2011-4-6 中山大学中山医学院生理教研室 王庭槐教授 Objectives: 1. Define edema, heart failure, congestive heart failure, and effective arterial blood volume. 2. Discuss the factors that produce generalized edema. 3. List the signs and symptoms of congestive heart failure. 4. Discuss the effects of fluid retention on stroke volume in patients with mild and severe heart failure. / 森马官方旗舰店 / 李宁官方商城 5. Discuss the mechanisms that contribute to renal salt and water retention in congestive heart failure. 6. Explain the physiological basis for the commonly used treatments for congestive heart failure. 7. Explain why patients with severe congestive heart failure may develop hyponatremia and indicate possible treatments for the hyponatremia. 8. Discuss long-term management of congestive heart failure. 目标： 1、定义水肿、心力衰竭、充血性心力衰竭、有效动脉血容量 2、讨论引起全身性水肿的因素 3、列举充血性心力衰竭的症状和体征，用你所学生理知识解释这些症状和体征产生的原因。 4、讨论液体潴留对轻度和重度心力衰竭病人心搏出量的影响 5、讨论充血性心力衰竭病人水、钠潴留的机制 6、解释充血性心力衰竭常用治疗方法的生理基础 7、试用所学知识，说明严重充血性心力衰竭病人低钠血症的产生原因以及可行的治疗方法 8、讨论充血性心力衰竭的长期治疗 9、学习心肌梗塞的症状，初步认识心电图变化等 10、讨论心力衰竭代偿期、失代偿期的表现及机制 Case Description H. Rodriguez. A 64-year-old Hispanic male with a past history of hypertension and a recent massive anterior wall myocardial infarction, presented to the Emergency Department complaining of fatigue and shortness of breath. He stated that the shortness of breath had been getting gradually worse over the past week. He denied any recent anginal pain, but reported a slow rise in weight from 145 lbs 66kg to 171 lbs 78kg . He complained that his feet hurt. He admitted to not complying with his low sodium diet. He stated that his medications included trans-dermal nitroglycerin, and ibuprofen for back pain. On a recent clinic visit his plasma Na+ level was 135 mg/dL，and his plasma creatinine level was 1.5mg/dL. Mr. Rodriguez lives alone; his wife passed away last year. He worked as a construction worker until retiring four years ago, as his physical condition worsened. He does not have fam