中南大学湘雅医院余再新吉林等2012-8.pptVIP

中南大学湘雅医院 余再新 吉林 2012－8;2;;;肺动脉炎;主肺动脉肉瘤;肺动脉肉瘤;肺静脉闭塞病;肺毛细血管瘤;右心衰竭的流行病学 左右心室的差别 急性肺栓塞 肺动脉高压;右心功能可有可无？;概念;流行病学;现状;现状; A, The inlet, trabeculated apical myocardium and infundibulum of the RV. The tricuspid and pulmonary valves are separated by the ventriculoinfundibular fold (VIF). B, Short-axis plane of the RV demonstrating its crescentic shape. C, The 4-chamber anatomic plane of the heart showing the moderator band (MB) and the more apical insertion of the tri- cuspid valve. D, Superficial muscle layer of the RV (dissection by Damian Sanchez- Quintana, University of Extremadura, Spain). SMT indicates septomarginal tra- beculation with its anterior (a) and poste- rior (p) arm; A-S, anterosuperior leaflet of the tricuspid valve; PT, pulmonary trunk; Ao, aorta; RA, right atrium; and LA, left atrium.;右心室运动;右心室血供的特点;主动脉压与左右冠脉血流;左右心室对后负荷的反应;右、左心室的相互作用;RV anatomy: Normal versus PAH (short axis view);Echocardiography image showing dilated right heart cavities (4-chamber view);右心室的代偿;特殊情况;Pathophysiology of failing RV;右心衰的特点;右心衰的常见病因;心室重构;心肌细胞凋亡;基因表达的异常 ;BNP;细胞因子、炎症反应、氧化应激等;;;;;Pathobiological processes in PAH;炎症与肺动脉高压;;;自身抗体; 血管收缩的物质增加：血清素，内皮素，血管紧张素II，血栓烷素A2。 血管舒张的物质减少：NO，前列环素，血管活性肠肽。;血吸虫卵刺激;血吸虫肺动脉高压的机制;2011;Imatinib-Tyrosine kinase inhibitor (PDGFR) ;;;;EVALUATION 研究结论： 伐地那非治疗能显著改善中国肺动脉高压患者的症状，提高运动耐量，改善血流动力学指标，使患者临床获益，而且相对价格便宜，是发展中国家治疗肺动脉高压的有效的一线治疗药物。;;;大块肺栓塞(massive pulmonary embolism)是指肺 栓塞2个肺叶或以上，或小于2个肺叶伴血压下降(体循环收缩压＜90 mm Hg，或下降超过40 mm Hg/5分钟)。 次大块肺栓塞(submassive pulmonary embolism)是指肺栓塞导致右室功能减退。;Massive, Submassive, and Low-Risk PE;次大块肺栓塞（Submassive）;低危肺栓塞（Low Risk PE);Therapy for Acute Massive, Submassive, and Low-Risk PE;急性肺栓塞的溶栓治疗建议;急性肺栓塞的溶栓治疗;急性肺栓塞的溶栓治疗;次大块肺栓塞溶栓治疗;导管介入治疗;慢性血栓栓塞性肺动脉高压;;;;CTEPH;CTEPH术前和术后的比较;谢 谢！