慢性肺源性心脏病-12课件.pptVIP

Clinical assessment of cor pulmonale: effect of MRI Magnetic resonance imaging (MRI) is probably the best method for measuring right ventricular dimensions because it produces the best images of the right ventricle In COPD patients good correlations have been noted between right ventricular free wall volume measured by MRI and PAP MRI is also a good method for detecting changes in right ventricular function, but it is expensive and available only in specialised centres Clinical assessment of cor pulmonale: place of Radionuclide ventriculography Radionuclide ventriculography allows the measurement of right ventricular ejection fraction (RVEF). An RVEF 40–45% is considered abnormal, but RVEF is not a good index of right ventricular function It gives only an estimate of the systolic function and is afterload dependent, decreasing when PAP and PVR increase The decreased RVEF observed in many COPD patients is caused primarily by increased afterload conditions and is not an indicator of “true” right ventricular dysfunction Right heart Left heart Pulmonary circulation Systemic circulation Cor pulmonale Acute cor pulmonale Chronic cor pulmonale Right ventricle enlargement Right ventricle hypertrophy and/or enlargement PTE ARDS 肺循环和右心的生理学特征 肺循环特点：低压、低阻、高流量系统 肺动脉压力： 收缩压：22mmHg 舒张压：10mmHg 平均压：15mmHg 右心室特点 壁薄、高顺应性 PAP=CO×(PVRA+PVRC+PVRV) pulmonary arterial hypertension resulting from diseases affecting the structure and/or the function of the lungs results in right ventricular enlargement (hypertrophy and/or dilatation) and may lead with time to right heart failure 肺动脉高压是肺心病的始动环节 PAP↑ → RV后负荷↑ →RV室壁张力↑ →心肌耗氧量↑ ，冠脉的阻力↑ →心肌血流减少，顺应性下降，而损害右室功能 右心室可发挥代偿功能以克服肺动脉的阻力，其结果逐渐发生右室肥厚 随着病情的进展，肺动脉压力持续升高，超过右心室的负荷，右心失代偿，右心排血量下降，右心收缩期末残留血量增加，舒张末压增高。促使右心室扩大和右心室功能衰竭 Definition Pulmonary hypertension complicating chronic respiratory disease is generally defined by the presence of a resting mean pulmonary artery pressure (PAP) 20 mmHg This is slightly different from the definition of