(精选)【医学课件课件】咯血(hemoptysis)教学课件.pptVIP

咯 血(hemoptysis);Hemoptysis;Hemoptysis;Hemoptysis;咯 血;The distinction between hemoptysis and hematemsis;咯血与呕血的鉴别 ;;1.Bronchial disease;The inflammatory process lead to the increase the permeability (通透性） of capillary and rapture of vessels in bronchial mucosa and then induce hemoptysis. blood-streaked sputum occasionally occur in the course of acute bronchitis. ;支气管疾病：支气管扩张症;支 气 管 肺 癌;咯血的病因和机制;2.Lung disease;Lung abscess may be related to putrid smelling sputum and expectoration of blood. hemoptysis occur in 25 percent of the patient of pulmonary embolism and infarction. pulmonary fungi and parasite infection may also serve as the sources of hemoptysis.;肺部疾病: 肺结核;肺 炎;2、肺部疾病;肺结核并咯血 ①结核病变使毛细血管通透性增高（少量咯血） ②病变侵蚀小血管破溃（中等量咯血） ③病变空洞壁动脉瘤破裂出血或继发性支扩形成小的动静脉瘘破裂出血（大量咯血） ;3.Cardiovascular disease;Hemoptysis due to mitral stenosis is frequently induced by physical exercise or excitement. Blood comes from a break in the pulmonary veins which have ruptured under high pressure. The bleeding is due to rupture of endobronchial vessels that from collateral(间接的) channels between the bronchial veins and pulmonary venous system. ;Many pulmonary emboli do not lead to pulmonary infarction, when they do, frank hemoptysis occurs in the minority (少数)of instance. when hemoptysis occur in the pulmonary infarction of the heart failure patient, the blood sputum usually appears within a few hours to a day after the embolus, and this is due to necrosis and hemorrhages into the alveoli.;Hemoptysis is also associated with congenital cardiac disease and aortic aneurysms ;心 血 管 疾 病;二尖瓣狭窄 因肺淤血压力↑致肺泡壁或支气管内膜毛细血管破裂 所致。若支气管粘膜下支气管静脉曲张破裂→ 大咯血。;4.Constitutional disease;4.其它;Clinical manifestation;1.The patient’s age;Elder patient with bloody sputum or streaked of bloody sputum, especially in the males with long history of smoking. cancer should be taken into account. Patients close contact with TB suffer, TB should be cons