右心室衰竭诊治进展__培训课件.pptVIP

* 七、右心衰竭的临床表现 液体潴留，从而可能导致周围水肿，腹水，全身水肿； 收缩期储备降低或低心排血量，可能导致活动耐量降低和疲劳； 房性或室性心律失常: 房扑,房颤； 心室充盈受限：颈静脉怒张及肝-颈静脉回流征阳性等； 肝脏肿大和压痛、胃肠道淤血等。 右心室功能的判定 心电图 胸片 超声心动图 MR 血管造影, 核素心肌显像 右心导管 右心室射血分数 Circulation, Volume 117(13).April 1, 2008.1717-1731 WHO肺动脉高压的功能分类 Ⅰ类：肺动脉高压病人，但体力活动不受限，一般体力活动不引起呼吸困难、乏力、胸痛或晕厥 Ⅱ类：肺动脉高压病人，引起体力活动轻微受限，休息时无不适，一般体力活动可引起呼吸困难、乏力、胸痛或近乎晕厥 Ⅲ类：肺动脉高压病人，引起体力活动明显受限，休息时无不适，小于一般体力活动便可引起呼吸困难、乏力、胸痛或近乎晕厥 Ⅳ类：肺动脉高压病人，不能进行任何形式的体力活动，出现右心衰竭的表现，甚至在休息时也可出现呼吸困难和（或）乏力，随着体力活动的增加而症状加重 6 MWT Methods The 6 MWT is a non-encouraged test performed on room air The corridor should be a minimum of 30 meters in length Required equipment Stop watch 2 cones Portable pulse oximeter Patient instructions: “The object of this test is to walk as far as possible for 6 minutes. You are permitted to slow down, to stop, and to rest as necessary. You may lean against the wall while resting, but resume walking as soon as you are able to.” “You will be walking back and forth around the cones (or chairs). You should pivot briskly around the cones and continue back the other way without hesitation..” 1级：小于300米； 2级：300-374.9米； 3级：375- 449.5米； 4级：大于450米。 （ 3-4级接近正常或达到正常） Chronic Right Ventricular Failure STAGE A At risk for RVF but Without structural Heart disease or Symptoms of HF e.g.Patients with: -Pulmonary Hypertension(early stages) -LV or valvular heart disease -Family history of CM or ARVD -Using Cardiotoxins or stimulants -Atherosclcrotic disease MANAGEMENT GOALS -Management of underlying condition or disease -Close monitoring of RV function -Family or genetic screening in Selected disease states -Discourage alcohol intake, Illicit drug use -Encourage regular exercise Structural Heart Disease or dysfunction 阶段A?????? 合并右心衰竭高危因素但无器质性心脏病或心衰症状; 如合并肺高压(早期)、左心室异常或瓣膜疾病、心肌病家族史或?ARVD、心脏毒性药物应用史、动脉粥样硬化性疾病等。 此阶段对应于左心衰竭分期的“前心衰阶段”(pre-heart?failure?)。? STAGE B RV dysfunction or structural heart diseas