心包积液课件_1

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1、PERICARDIALEFFUSION(心包积液)PericardialEffusionPericardialeffusionmaydevelopasaresp-onsetoinjuryoftheparietal(壁层的)pericardiumwithallcasesofacutepericarditis.心包积液可出现于所有急性心包炎中，为壁层心包受损的反应。PericardialEffusionItmaybeclinicallysilent,butiftheaccum-ulationoffluidcausesintrapericardialpres-sureto

2、increase,resultingincardiaccomp-ression,thesymptomsofcardiactamponadedevelop.临床上可无症状，但如果液体积聚导致心包腔内压升高而产生心脏压迫则可出现心脏压塞。PericardialEffusionThedevelopmentofincreasedintrapericardialpressuresecondarytopericardialeffusiondependsonseveralfactors:①Theabsolutevolumeoftheeffusion,②Therateoffluid

3、accumulation,and③Thephysicalcharacteristicsofthepericardiumitself.继发于心包积液的心包腔内压升高与以下几个因素有关：①绝对的积液量；②积液产生的速度；③心包本身的特性。PericardialEffusionThepericardicalspaceinhumansnormallycontainsbetween15and50mloffluid.Ifadditionalfluidaccumulatesslowly,thepericardiumstretches;thepericardialsaccanacc

4、ommodateupto2literswithoutelevationofintrapericardialpressure.正常人心包腔容纳15-50ml液体，如液体积聚缓慢，心包伸展，心包腔内可适应多达2升液体而不出现心包腔内压升高。PericardialEffusionIfadditionalfluidisrapidlyaddedtoavolumeexceedingabout150to200ml,amarkedriseofintrapericardialpressureoccurs.如液体迅速增加超过150-200ml，则心包腔内压会显著上升。Pericardi

5、alEffusionWithoutCardiacCompression(不伴心脏压塞的心包积液)History(病史).Patientswhodeveloppericardialeffusionwithoutelevationofintrapericardialpress-uremayhavenosymptomswhatsoever.有心包积液但没有心包腔内压升高的患者可以没有任何症状。HistoryOccasionallythesepatientscomplainofaconstantoppressivedullacheorpressureinthechest.偶

6、尔这些病人会主诉有持续性的胸部压迫性钝痛或压迫感。HistoryLargepericardialeffusionsmaycausesymptomsbymechanicalcompressionofadjacentstructures,includingdysphagiafromesophagealcompression,coughduetobronchial/trachealcompression,大量心包积液则可因邻近组织机械性受压而产生症状。包括食管受压引起吞咽困难，气管、支气管受压引起咳嗽，Historydyspneafromlungcompressionwi

7、thsubsequentatelectasis（肺不张）,hiccups（呃逆）duetophrenicnervecompression,orhoarseness（声嘶）duetorecurrentlaryngealnevercompression.肺受压及随后出现的肺不张导致呼吸困难，膈神经受压导致呃逆，或喉返神经受压致声嘶，邻近的腹腔脏器受压可以产生恶心和腹胀感。HistoryNauseaandasenseofabdominalfullnessmaybepresentfrompressureonadjacentabdominalviscera.Physica