结核性心包炎 浙江大学课件.ppt

临床表现 症状： 劳力性呼吸困难 静脉系统淤血的症状 体征 心脏体征：心包叩击音 动脉系统缺血：SBP?，部分奇脉 静脉系统淤血：颈静脉怒张Kussmaul征,肝大腹水下肢水肿，黄疸、蜘蛛痣和肝掌 辅助检查 化验检查：轻度贫血、白蛋白减少，胸腹水为漏出液 心电图：QRS波低电压、T波平坦或倒置；50%患者有房颤； X线：心包钙化，心缘弧弓消失 UCG：心包增厚、钙化、少量心包积液，吸气时室间隔突入左室 CT、MRI：心包增厚 心导管检查 X线：心包钙化，心缘弧弓消失 CT：心包增厚 X线：心包钙化，心缘弧弓消失 诊 断 临床表现 静脉压升高 UCG、CT心包增厚、钙化 鉴别诊断 肝硬化腹水 右心衰 限制性心肌病 治 疗 心包切除 越早越好 * * FIGURE 64-1 ??The pericardial reflections near the origins of the great vessels shown after removal of the heart. Note that portions of the caval vessels are within the pericardial space. (From Gabella G [sect ed]: The pericardium. In Gray H, Williams PL, Bannister LH [eds]: Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery. New York, Churchill-Livingstone, 1995, p 1471.)  * Commonly, there is an antecedent infection of the respiratory tract, the , acute idiopathic pericarditis is then appropriate * The ST-segment alterations in the ECG usually disappear after 1 or more weeks, but the abnormal T waves may persist for several years and be a source of confusion in persons without a clear history of pericarditis 心包疾病 浙江大学附属邵逸夫医院心内科 周 斌 全 The visceral pericardium is a serous membrane that is separated by a small quantity (15 to 50 mL) of fluid, an ultrafiltrate of plasma from a fibrous sac, the parietal pericardium. prevents sudden dilatation of the cardiac chambers during exercise and with hypervolemia. restricts the anatomic position of the heart minimizes friction between the heart and surrounding structures prevents displacement of the heart and kinking of the great vessels, probably retards the spread of infections from the lungs and pleural cavities to the heart 心包炎（pericarditis） 急性心包炎（acute pericarditis） 纤维蛋白性和渗出性心包炎 慢性心包炎（chronic pericarditis） 慢性粘连性心包炎 慢性渗出性心包炎 缩窄性心包炎 急性心包炎—病因 特发性 感染性因素：细菌（结核性最多见）、病毒、真菌、寄生虫 肿瘤：原发性间皮细胞肿瘤、继发性 自身免疫：风湿性、SLE、RA、AMI、心包切开后综合症 代谢疾病：尿毒症、甲减 邻近器官疾病：肺梗死、胸膜炎、主动脉夹层 物理性：外伤，放疗 病 理 纤维蛋白性—干性 渗出性—湿性：心包积液、心包填塞 病理生理 量与速度 急性心包炎特征 典型胸痛 心包摩擦音 特异性心电图表现