内科学 慢性阻塞性肺病和慢性肺源性心脏病.ppt

WHO classification of pulmonary hypertension Pulmonary arterial hypertension Idiopathic pulmonary arterial hypertension (primary pulmonary hypertension). Familial pulmonary arterial hypertension (FPAH), Related to:Collagen vascular disease. Portal hypertension.HIV infection.Drugs/toxins: others Pulmonary venous hypertension Left-sided atrial or ventricular heart disease Left-sided valvular heart disease. Pulmonary hypertension associated with hypoxaemia Chronic obstructive pulmonary disease Interstitial lung disease Sleep disordered breathing Alveolar hypoventilation disorders Chronic high altitude exposure. Pulmonary hypertension due to chronic thrombotic and/or embolic disease Thromboembolic obstruction of proximal pulmonary arteries Obstruction of distal pulmonary arteries Pulmonary embolism (thrombus, tumour, ova, parasites, foreign material) In situ thrombosis Sickle cell disease. Pulmonary hypertension associated with miscellaneous disorders Pathogenesis of pulmonary hypertension 1、血管器质性病变： Thickening,stenosis/obstruction ? decrease in vascular bed ? pulmonary hypertension ? right ventricular hypertrophy Cor pulmonale pressure area R= 2、Physiological aspect hypoxia Body fluid factor Tissue Factor Neurologic Factor Histamine, ↑permeability to Ca++ hypoxia,hypercapnia AT-II,5-TH, LT,TXB2,PG ↑Couple-excitation ↑sympathetic tone Constriction of pylmonary artery ? Pulmonary hypertension Pathogenesis of pulmonary hypertension 3、 ↑Blood volume and viscosity Clinical Features Cardio-pulmonary compensatory phase Symptoms：chronic cough,sputum,dys