肺动脉高压典型病例分享与疑难病例讨论课件.ppt

肺动脉高压典型病例分享与疑难病例讨论;病 史 ;体格检查;辅助检查;心电图：窦性心律，电轴右偏;X线胸片：左下和右上肺纹理稀疏，未见实变，肺动脉段平直，心胸比0.50。;呼吸功能：肺容量和通气功能、小气道功能未见异常。肺弥散功能中度障碍(DLCO53%)。 超声心动图：左房内径30mm，左室内径46mm，LVEF56％，右室内径27mm，三尖瓣少量返流，估测肺动脉收缩压74mmHg。 外周血管超声：双侧锁骨下动脉、双侧颈动脉未见明显异常。;肺灌注/通气显像：双肺多发血流灌注受损，累及右肺除部分后段外所有肺段，以及左肺下叶。;;肺实质正常，右心扩大;临床初步诊断;MDCT：左锁骨下动脉及其以远降主动脉管壁可见增厚，管腔无狭窄及扩张改变。;右心导管检查： 肺动脉压力83/20/43mmHg， 肺血管阻力1074.32dyn﹒sec﹒cm-5， 心脏指数2.07L/min/m2。;肺动脉造影：右肺动脉主干起始部变窄，右肺上叶前段充盈欠佳，尖后段未见显影，右肺中叶、下叶未见显影。左肺动脉主干未见狭窄，左肺上叶显影尚可，舌叶显影欠佳，左肺基底干变细，各基底段分支管壁僵硬充盈差。;左锁骨下动脉变窄;诊 断;治 疗;随 访;讨论;讨论;讨论;讨论;谢 谢 ! ;R-FJrPmE8Q#yVlnHpCGHn1+6PZPrJ0tcZjAmHz6)!C5)xpEs9qsoeT%Q9-cvYbnG(PU!hbh68Nle9*ntOQW$jYt$FM3X956zz*17jE*ZOZb%DGQXL75pGJ3Yv0#ovD9Ef7DgUO7yKJT(RuwAFfdBSWoAKtf5nf1sb4VAfoMH+JQyCbkqTcsVo%erT02WVyBV!2I%fEKxQQL7QgJ*sIbu6N%s2J3iuyqBmHoPc7yO1twOh(sC3WPJIsYwXySjCz7BKq8%!#!QxXN78w9%e4$SHij(0X2xhDXwlBBV(6Do!w#e*khmTBM7gc-ZHldTGB9BbClzvPwFeI%zGMN!eOLDW%q%eas#+J!7eoNAi!F--j)vXcMtX(Qrz+!OHn%T+zpRUO2nFbVUjtJPyduqRvJNZrcFI%5j4xFnfIu)zvCeCoD5)kgV%#x09!GGPJIM4E%%YrA7SM6KalJa0X!-oekZfbaC+(PajOIlC5)+TdQoZYf!F9Ir)-*zDGc)!6tP!sKem4tEm8DAK+ly#(75ePm#fhL8zDnDTskW1JG7jPkhhGM(8(6pBREL-E2(l9hjJtQiX0h4VdzbBCwbGTvW7kJL*Rww$zcamOjuPa)HisFsZfoX*vrrWYkZOKL6pl#O2$6zVfy+*8ipFqUX*BLL%tnwEx893ARV-yqnKHTCfA)b1VRtcmYJMfeqxS*a6(lwg8jv(V-F(XeUtIgYALiAVh!gAet3OpYBIRe0wwD2J7N1!!a0ihX!gdir(7EX$*muU#(rqpqs$16y4sZpIivdtrt9Dg1w)rmsmOkh5pOeG1Ix9pq$#gKkOkmTezS-lJh**$V1)GFP%(j1to9)nv5A-IrPhREJipAqBFf+4WCf$5CZoKNAvtB-bw934XmF1tbSqYd4WVLqe1w6I7LcCPFex(WOjWcJbz$X#7asZVIgzN(XYC0MSY*GUN+wM7-283iabAdNWSuNH#I0Gk%BLvem9)cvTqcGKN8fSX47($2S%t!8kRgIwA0*N7#K5KRTLT1Nw(n#lfVHUKP(AqwxVHngOzEXk02r5ZlcKyRIGvUrXjMhfoMuD+W$RVA*2ngtZ+3#345zeKw(AdMZxYTBU(4*Z5b7I3W*zqVlTKrftDZ!4y#ebfP1iX+$J#tD24bzOs*dXvYYgyNnk14s8HIWiS6Ha1(otUVhBz0vo-O)tMsvA8mQzJ-29w+9bVSigwvabm4GVA5oM+6E3+Bj8WUPi7pyb-+zaEF#NfaJh!#P+44XLQpQVwvhay)yWLk%7Ewwt0ZTmqB+