非心源性胸痛幻灯片.pptVIP

非 心 源 性 胸 痛Non-Cardiogenic Chest Pain 非心源性胸痛的病因Cause of Non-cardiogenic chest painpain 胸壁疾病(disease of chest wall)： 1)急性皮炎(acute dermatitis) 2)皮下蜂窝织炎(subcutaneously dermatocellulitis) 3)带状疱疹(herpes zoster) 4)肌炎(myositis) 5)肋软骨炎(costal chondritis) 6)肋间神经炎(intercostal neuritis) 7)肋骨骨折(fracture of rib) 8)急性白血病(acute leukemia) 9)多发性骨髓瘤(multiple myeloma )等。 呼吸系统疾病(disease of respiratory system)： 1)胸膜炎(pleurisy) 2)胸膜肿瘤(pleural tumors) 3)气胸(pneumothorax) 4)急性气管-支气管炎(acute trachea-bronchitis) 5)肺炎(pneumonia) 6)肺癌(lung cancer)等 纵膈疾病(diseases of mediastinum)： 1)纵隔脓肿(mediastinal abscess) 2)纵隔肿瘤(mediastinal mass) 3)纵隔气肿(mediastinal emphysema) 消化系统疾病(disease of digestive system)： 1)食管疾病(esophageal disease) 2)肝脓肿（hepatapostema） 3)肝癌（hepatic cancer) 4)胆囊疾病（gallbladder disease)等 可导致胸痛的食管疾病： 1）胃食管反流病(Gastroesophageal reflux disease GERD) 2）食管裂孔疝(hiatus hernia) 3）食管憩室（esophageal diverticulum) 4）贲门失弛缓症(cardiac achalasia) 5) 食管癌（carcinoma of esophagus） 6）食管痉挛（esophageal spasm) 胃食管反流病包括NERD和RE，引起的胸痛多在进食后1小时内发生，疼痛程度不一定与病变的轻重程度一致。严重的疼痛与心绞痛类似。 GERD的诊断除根据症状和体征外，辅助检查包括食管pH和压力检测以及胃镜检查。 LA Classification of RE 食管裂孔疝：疼痛诱因与反流性食管炎类似，轻重与疝囊大小有关。 食管憩室：憩室内食物残留引发炎症或较大憩室牵拉食管可引起疼痛。 贲门失弛缓症：疼痛多位于胸骨后，发作有时酷似心绞痛，甚至舌下含硝酸甘油片可缓解。当梗阻上段食管进一步扩张时疼痛反可减轻。 食管癌：表现为吞咽食物时有胸骨后或剑突下疼痛，性质可为烧灼样、针刺样或牵拉样。疼痛部位常不完全与食管内病变一致，解痉剂可以暂时缓解疼痛。 食管痉挛导致的胸痛与心绞痛非常相似，不易鉴别，鉴别诊断靠食管测压和食管吞钡检查。 * Lundell et al. Gut. 1999;45:172-180. LA Grade D ?1 mucosal breaks bridging the tops of folds and involving 75% of the circumference ?1 isolated mucosal breaks 5 mm long LA Grade B LA Grade C ?1 mucosal breaks bridging the tops of folds but involving 75% of the circumference ?1 isolated mucosal breaks ?5 mm long LA Grade A * * * Key Points LA classification system is a 4-grade system EE severity is graded based on the extent of esophageal injury Esophageal injury is assessed according to the extent of erosions, or mucosal breaks Isolated mucosal breaks, confined to the tops of mucosal folds, indicate less severe EE Mucosal breaks that c