室间隔缺损医疗护理事项说明查房 - 副本.pptVIP

* 室间隔缺损的护理 The nursing for ventricular septal defect 定义（definition ） 室间隔缺损是指室间隔在胎儿时期因发育不全，在左右心室之间形成的异常通道。室间隔缺损引起血液自左向右分流，导致血流动力学异常。 The?ventricular septum?in the fetal period for dysplasia ,abnormal?passage is formed in the?left and right ventricular.?Ventricular septal defect caused by blood?from left to right?shunt,?resulting in abnormal hemodynamics. 病因( Pathogeny)  心血管畸形的发生主要由遗传和环境因素以及相互作用所致 The?congenital?malformation?relates?to?genetic?factor,?environmental?factor?or?the?interaction?of both?factors. 1.早期宫内感染(early intrauterine infection ) 2.孕母有放射线接触和服用药物(a radiation?exposure and ?medications ) 3.孕妇代谢紊乱性疾病(metabolic?disorder disease ) 4.妊娠早期酗酒、吸食毒品等 分类（classification ） 根据缺损的解剖位置不同，通长分为膜部缺损、漏斗部缺损和肌部缺损三大类。其中以膜部缺损最常见。绝大多数是单个缺损，偶见多个缺损。According to the different anatomical?defects usually?divided into?membrane?defect infundibular defect and ?muscular defect?three categories The?most common is?membrane?defect.?The vast majority?are single?defect, many?defects are rare. 病理生理（Pathophysiology ） 室间隔缺损时，左心室血流向右分流，分流量取决于两侧心室间的压力阶差、缺损大小和肺血管阻力。肺动脉压力随右心负荷增大而逐渐增高。 When the ventricular septal defects,the?left ventricular flow?shunt,?flow depends on?the pressure?order?difference between the?two ventricles,?defect size?and pulmonary vascular resistance. The pulmonary arterial?pressure gradually increases with?right heart load ?. ? 临床表现（clinical manifestation ） 症状（symptom） 呼吸道感染 respiratory 乏力、多汗 Fatigue,?sweating 气促、心悸 Shortness 、palpitation 2、X线检查(x-ray examination ) 中度以上缺损时，心影轻到中度扩大，左心缘像左下延长，肺动脉段突出，重度梗阻性肺动脉高压时，肺门血管影明显增粗， 甚至肺血管影呈残根征 3、超声心动图(echocardiogram ) 示左心房、右心室内径增大。多普勒超声证实有左心室向右心室的分流。 治疗(treatment ) 1、缺损小、无血流动力学改变者，可暂观察，部分病例可自行闭合。 patient who defect is small or ?hemodynamic is not changeing,?can temporarily?observation,?some cases can?close automatically. 治疗(treatment ) 2、缺损大、分流量大于50%或伴肺动脉高压的婴幼儿，应早期在低温体外循环下行心内直视修补术。 Defect ofinfants and young children,?divided?flow?is larger than 50%?or?with pulmonary hypertension? w