心瓣膜病本科PPT课件.ppt

**Theleftatriumhasbeenopenedtorevealthemostcommonprimarycardiacneoplasm--anatrialmyxoma.Thesebenignmassesaremostoftenattachedtotheatrialwall,butcanariseonavalveorinaventricle.Theycanproduceaballvalveeffectbyintermittentlyoccludingtheatrioventricularvalveorifice.Embolizationoffragmentsoftumormayalsooccur.Myxomasareeasilydiagnosedbyechocardiography.****一、症状：一般在二尖瓣口1.5cm2（中度狭窄）时始有明显症状，我国患者发病年龄逐渐后移，多于20～40岁出现症状。（一）呼吸困难为最常见的早期症状。体力活动、精神紧张、发热、阵发性心房颤动、贫血和妊娠等使心排血量或心率增加，左房压进一步升高，肺淤血加重，故最先为劳力性呼吸困难或仅在上述情况时诱发呼吸困难。随着狭窄加重，出现体息时的呼吸困难、端坐呼吸和阵发性夜间呼吸困难，甚至反复发生急性肺水肿。（二）咯血有下列几种表现：?突然咯出较大量鲜血，通常见于严重二尖瓣狭窄，有时为首发症状；由于支气管静脉同时回流入体循环静脉和肺静脉，当肺静脉压突然升高时，可致粘膜下已淤血扩大而壁薄的支气管静脉破裂出血；?伴阵发性夜间呼吸困难或咳嗽时的血性痰或带血丝痰；?急性肺水肿时咯出大量粉红色泡沫状痰；?肺梗塞伴咯血。（三）咳嗽常见，特别在冬季明显。有的患者在躺卧时干咳，可能与支气管粘膜淤血水肿易罹支气管炎或左房增大压迫左主支气管有关。（四）声嘶较少见。由于扩大的左房和肺动脉压迫左喉返神经致其麻痹引起。****二尖瓣返流早期无症状时，仅需抗生素预防。给药方法类似二尖瓣狭窄。当发生心房颤动时，应用洋地黄以减慢心室率。减少后负荷的药物，如亚硝酸盐类和抗高血压药，有利于二尖瓣返流病人维持其前向搏出容量。一旦发生心力衰竭，需用利尿剂和正性收缩力药，但主要应考虑外科手术。********ThisistheSampleColumnChartsslide.Tocreatethisparticularslide,copyandpastethesampleintheSlideSorterviewasfollows:SelectView/SlideSorterHighlighttheSampleColumnChartspageandselectEdit/CopyPlacethecourserwhereyouwantthenewslidetobeandselectEdit/PasteDouble-clickonthepasted-inslidetoreturntoSlideviewToaccessthecolumnchart,right/clickonthechartandselectchartobject/openfromthemenu.ThiswillopenthechartinMicrosoftGraph.Youcanmakeanychangestothechartandspreadsheethere.Whenyouarefinishedmakingyourchanges,selectFile/Exitandreturnto…fromthemenubar.THISMETHODISPREFERREDTODOUBLE-CLICKINGTHEGRAPHANDOPENINGITINPOWERPOINT.Double-clickingthegraphcansometimesreformatthesizes,colors,animationsandfontsinyourgraph.**ThisistheSampleColumnChartsslide.Tocreatethisparticularslide,copyandpastethesampleintheSlide