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ID:59535996
大小:1.24 MB
页数:42页
时间:2020-11-09
《室间隔缺损护理查房副本幻灯片课件.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、室间隔缺损护理查房副本病因(Pathogeny)心血管畸形的发生主要由遗传和环境因素以及相互作用所致The congenital malformation relates to genetic factor, environmental factor or the interaction ofboth factors.1.早期宫内感染(earlyintrauterineinfection)2.孕母有放射线接触和服用药物(aradiation exposureand medications)3.孕妇代谢紊乱性疾病(metabolic disorderdisease)4.妊娠
2、早期酗酒、吸食毒品等分类(classification)根据缺损的解剖位置不同,通长分为膜部缺损、漏斗部缺损和肌部缺损三大类。其中以膜部缺损最常见。绝大多数是单个缺损,偶见多个缺损。Accordingtothedifferentanatomical defectsusually dividedinto membrane defectinfundibulardefectand musculardefect threecategoriesThe mostcommonis membrane defect. Thevastmajority aresingle defect,man
3、y defectsarerare.病理生理(Pathophysiology)室间隔缺损时,左心室血流向右分流,分流量取决于两侧心室间的压力阶差、缺损大小和肺血管阻力。肺动脉压力随右心负荷增大而逐渐增高。Whentheventricularseptaldefects,the leftventricularflow shunt, flowdependson thepressure order differencebetweenthe twoventricles, defectsize andpulmonaryvascularresistance.Thepulmonaryart
4、erial pressuregraduallyincreaseswith rightheartload .临床表现(clinicalmanifestation)2、体征(signs):(1)心前区轻度隆起Theareabeforetheheart slightlyelevated(2)胸骨左缘3-4肋间闻及3级以上粗糙响亮的全收缩期杂音。Leftparasternal intercostal can heard 3-4 and morethan3 rough loud holosystolicmurmur.(3)发育迟缓和不良Growthretardation andp
5、oor辅助检查(laboratory examinations)1、心电图(electrocardiogram):小型VSD正常范围,大型VSD为左、右心室合并肥大。重度肺动脉高压时,显示双心室肥大、右心室肥大或伴劳损。2、X线检查(x-rayexamination)中度以上缺损时,心影轻到中度扩大,左心缘像左下延长,肺动脉段突出,重度梗阻性肺动脉高压时,肺门血管影明显增粗,甚至肺血管影呈残根征3、超声心动图(echocardiogram)示左心房、右心室内径增大。多普勒超声证实有左心室向右心室的分流。治疗(treatment)1、缺损小、无血流动力学改变者,可暂观察,部
6、分病例可自行闭合。patientwhodefectissmallor hemodynamicisnotchangeing, cantemporarily observation, somecasescan closeautomatically.治疗(treatment)2、缺损大、分流量大于50%或伴肺动脉高压的婴幼儿,应早期在低温体外循环下行心内直视修补术。Defectofinfantsandyoungchildren, divided flow islargerthan50% or withpulmonaryhypertension who shouldbeearly
7、 inthedownlink hypothermiccardiopulmonarybypassand openheartsurgery.3、严重肺动脉高压、有右向左逆向分流者,禁忌手术。patientwhohaveaseverepulmonaryhypertension, righttoleft shunt operation inreversecannotoperate.护理问题(Nursingproblems)术前(preoperative):1、心输出量减少(decreasedcardiacoutput)2、活动无耐力
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