心包疾病浙江大学附属邵逸夫医院心内科周斌全.pptxVIP

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—病因;病 理;病理生理;急性心包炎特征;症 状;体 征;Ewart 征：大量心包积液心脏向左下移位，压迫左肺，在左肩胛下角区出现肺实变表现（浊音、语颤增强、支气管呼吸音） Kussmaul征：吸气时颈静脉扩张 ;辅 助 检 查;ST段弓背向下抬高（AVR,V1除外），PR段压低，;CT,MRI;心包穿刺;心包穿刺与心包积液分析;纤维心包镜检查;诊 断;coxsackievirus A or B, influenza, echovirus, mumps, herpes simplex, chickenpox, adenovirus, or EBV (细胞积液中分理出病原，病毒抗体滴度升高） * HIV 感染 Pericardial effusion is the most common cardiac manifestation usually secondary to infection (often mycobacterial) or neoplasm (lymphoma or Kaposi's sarcoma) Pericardial effusion in full-blown AIDS is associated with a shortened survival.;临床表现 所有年龄段均可发生，好发于年轻人 病毒性感染后10-12天 发热，胸痛，常有心包摩擦音 ? 病人再发 治疗 卧床休息bed rest aspirin 无效? nonsteroidal anti-inflammatory agents, such as indomethacin (25 to 75 mg qid), 加用秋水仙素or a glucocorticoid (e.g., prednisone, 40 to 80 mg daily) 禁忌抗凝 ; 出血性心包炎 ;少数患者找不到原发病灶 慢性病的全身表现，如消瘦、乏力、低热盗汗 常发展成缩窄性心包炎 ;缩 窄 性 心 包 炎;病 因;病理和病生;呼吸的影响，吸停脉的原理;临床表现;辅助检查;X线：心包钙化，心缘弧弓消失;X线：心包钙化，心缘弧弓消失;诊 断;鉴别诊断;治 疗