{"nowTime30":1711664508098,"lyBarModerator":null,"metaSearch":{"description":"心脏穿透伤的病理和临床表现,一方面取决于受伤机制,即穿透物的性质、大小和速度。例如,火器伤所致者80%以上现场死亡,而刀刺伤约半数仍可到达医院。另一方面,主要取决于损伤的部位、伤口的大小以及心包裂口的情况。心包裂口足够大时,心脏的出血可通畅流出体外或流入胸腔、纵隔或腹腔,心包内积血(血心包)量不多,","keywords":"穿透性心脏损伤表现_洞医","title":"穿透性心脏损伤表现_洞医","channels":null},"identificate":{"id":"0300b4bddfaf11e6a61c00163e04584d","isDel":0,"createAt":1484985344390,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","realName":"赵玉","certifiedStatus":2,"phone":"111111111111","email":"2276635444@qq.com","hospitalId":"31c19c1b453011e69d4700163e005165","departmentId":"2000","illName":"","illId":"793a72a2bb5f11e6a61c00163e04584d","cardType":1,"cardImg":"http://01luntan.com/ly_img/1484985951761.jpg","idCardImg":"","identityType":2,"stop":0,"departmentName":"儿科","hospitalName":null},"canEdit":null,"adList":[],"lyBar":{"id":"1675","isDel":0,"createAt":1483439337899,"createBy":"system","createName":"system","updateAt":0,"updateBy":null,"updateName":null,"userId":null,"name":"北京协和医院血管外科","type":101,"twoCode":"http://zhao01.com/zly_img/zly_wx.jpg","image":null,"provinceId":"110000","cityId":"110101","illId":null,"hospitalId":"15009","keyWord":null,"totleTopic":0,"barDesc":null,"discussBarType":null,"metaSearch":"{\"description\":\"洞医网为您提供:协和医院血管外科谁好、北京协和医院血管外科中心病友的治疗经验等相关信息,让您在便捷的求医路上不花一分冤枉钱。协和 血管外科论坛欢迎您\",\"keywords\":\"北京协和医院血管外科中心_协和医院血管外科谁好_协和 血管外科_洞医\",\"title\":\"北京协和医院血管外科中心_协和医院血管外科谁好_协和 血管外科_洞医\"}","adInfo":null},"isLikeThisTopic":null,"lastTopics":[{"id":"1138","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"心脏手术中要慎用速尿","content":"
速尿又名呋塞米(furosemide),是强效髓袢利尿剂。他减低肾脏氧耗,促进利尿并保护肾脏功能。但同时也扩张血管,降低前负荷,利尿的同时易产生低血容量和低钾血症,大量利尿剂不利于体外循环心脏手术病人后期的循环稳定。
\n在体外循环中,由于预充大量液体,包括平衡液、明胶或羟乙基淀粉溶液等,血液稀释往往使hct降低至17%~18%(少数低至15%)。为了排除过量的液体负荷,使hct在停机前后达21%~24%,一些灌注医师简便的处理办法就是给速尿10~20mg,结果使病人大量利尿,体外循环后麻醉医师不得不快速输血输液和补钾,出现了“大脱大补”的忙乱局面,使病人循环处于不稳定状态。曾有1名54kg的女性病人,行双瓣替换术,术前hct为34%,体外循环开始hct降至17%,给速尿15mg后,转中尿量达1#600ml,转后hct为23%,术后达27%,但术后4小时尿量高达2#300ml。
\n我们多年的经验表明,体外循环中一般不要用速尿来强制病人排出体内过多的液体,除非病人尿量少于1ml·kg-1.h-1。因为血液稀释本身可以使病人抗利尿激素分泌减少,肾血流量增加。只要血压回升,病人很快就会来尿。如果病人实在没尿,近期又未接受过速尿者,或换瓣病人术前肝大有明显水潴留者,成人开始可以给予2.5~5.0mg,小儿0.5~1mg/kg,不可一开始就用较大剂量速尿。除非病人正在使用利尿剂才可能将起始量增至10~20mg,否则会使病人发生容量治疗问题和电解质失衡。
\n对血液过度稀释的预防与处理可应用下列方法:(1)麻醉医师在体外循环前不要过多输液,只要循环稳定输液量5~10ml·kg-1.h-1即可;(2)灌注医师按体重大小采用适当的氧合器,预充量要适当,小儿更应做到氧合器和管道小型化,目的是尽量减少预充的液体量和稀释度;(3)当体外循环中hct<18%时,可采用人工超滤装置,减少速尿的用量,以免打乱病人自身的调节机制。
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心律失常是心脏手术后常见的并发症之一,尤其在心内直视手术后,发生率可高达48%-74%。心律失常的发生,增加了手术后的危险性,而严重的心律失常,常常成为心脏手术病人术后死亡的主要原因,因此加强对心律失常的监测和护理,有着极其重要的临床意义。现将我院1998年6月2002年8月25例心脏体外循环术后心律失常患者护理体会报告如下。
\n1、临床资料
\n2、心律失常类型与常见诱因
2.1心脏术后心律失常的常见类型
2.1.1室性心律失常包括室性早搏、室性心动过速、心室颤动等,是心脏手术后最常见的并发症。
2.1.2 房性心律失常包括房早、房扑、房颤。
2.1.3房室传导阻滞临床上常见于巨大的心室间隔缺损、法乐氏四症等严重畸形纠正术后。
2.1.4非传导性心动过缓常见于体外循环中,心脏复跳后出现心肌收缩无力和心动过缓
2.2心脏手术后心律失常的常见诱因
2.2.1手术前的心功能状态术前心功能状态对术后心律失常的发生有影响。
2.2.1手术本身的打击心律失常的发生率高低与心脏病类型及手术有关,手术操作可引起心脏传导组织产生可逆性或不可逆性损伤,这些损伤可导致心脏异位激动,心动过速或房室传导阻滞。
2.2.3术后血液动力学状态的影响血压高多伴有体循环阻力的升高,
2.2.4 术后机体内环境稳定失平衡低血钾是常见心律失常诱发因素。
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男,60岁,2016年经当地医院诊断,腹主动脉瘤,前壁后壁均有斑块,前壁斑块5.4×2.7厘米,后壁5.2×1.4厘米,并伴有心梗,脑梗,高血压,糖尿病。请给予治疗建议
","barId":"1675","topicTypeId":null,"topicThemeId":"1020","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"2046","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"升主动脉瘤62mm能做手术吗?风险大吗","content":"男61岁一月前发现前胸闷后背疼痛 气喘咳嗽 在十堰市太和医院做胸部ct 彩超 心电图 医生确诊升主动脉瘤62mm
\n请问这个能做手术吗?风险大吗
","barId":"1675","topicTypeId":null,"topicThemeId":"1019","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"3276","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"动脉硬化闭塞症临床表现","content":"动脉硬化闭塞症临床表现
无症状期或隐匿期
其过程长短不一,包括从较早的病理变化开始,直到动脉粥样硬化已经形成,但尚无器官或组织受累的临床表现。
缺血期
症状由于血管狭窄、器官缺血而产生。
坏死期
由于血管内血栓形成或管腔闭塞而产生器官组织坏死的症状。
硬化期
长期缺血,器官组织硬化(纤维化)和萎缩而引起症状。 动脉硬化闭塞症
不少病人不经过坏死期而进入硬化期,而在硬化期的病人也可重新发生缺血期的表现。
按受累动脉部位的不同,本病有下列类别:①主动脉及其主要分枝粥样硬化;②冠状动脉粥样硬化;③脑动脉粥样硬化;④肾动脉粥样硬化;⑤肠系膜动脉粥样硬化;⑥四肢动脉粥样硬化等。
临床表现主要是有关器官受累后出现的病象。
(一)一般表现:脑力与体力衰退,触诊体表动脉如颞动脉、桡动脉、肱动脉等可发现变宽、变长、纡曲和变硬。
(二)主动脉粥样硬化:大多数无特异性症状。叩诊时可发现胸骨柄后主动脉浊音区增宽;主动脉瓣区第二心音亢进而带金属音调,并有收缩期杂音。收缩期血压升高,脉压增宽,桡动脉触诊可类似促脉。x线检查可见主动脉结向左上方凸出,主动脉扩张与扭曲,有时可见片状或弧状的斑块内钙质沉着影。
主动脉粥样硬化还可形成主动脉瘤,以发生在肾动脉开口以下的腹主动脉处为最多见,其次是主动脉弓和降主动脉。腹主动脉瘤多因体检时查见腹部有搏动性块肿而发现,腹壁上相应部位可听到杂音,股动脉搏动可减弱。胸主动脉瘤可引起胸痛、气急、吞咽困难、咯血、声带因喉返神经受压而麻痹、气管移位或阻塞、上腔静脉和肺动脉受压等表现。x线检查可见主动脉的相应部位增大;主动脉造影可显示出梭形或囊样的动脉瘤。二维超声显像、电脑化x线断层显像、磁共振断层显像可显示瘤样主动脉扩张。主动脉瘤一旦破裂,可迅速致命。动脉粥样硬化也可形成夹层动脉瘤,但较少见。 动脉硬化闭塞症--影像
冠状动脉粥样硬化
(三)冠状动脉粥样硬化:可引起心绞痛、心肌梗塞以及心肌纤维化等,将在下节详述。
(四)脑动脉粥样硬化:脑缺血可引起眩晕、头痛与昏厥等症状。脑动脉血栓形成或破裂出血时引起脑血管意外,有头痛、眩晕、呕吐、意识突然丧失、肢体、瘫痪、偏盲或失语等表现。脑萎缩时引起痴呆,有精神变态,行动失常,智力及记忆力减退以至性格完全变化等症状。
(五)肾动脉粥样硬化:临床上并不多见,可引起顽固性高血压,年在55岁以上而突然发生高血压者,应考虑本病的可能。如有肾动脉血栓形成,可引起肾区疼痛、尿闭以及发热等。
(六)肠系膜动脉粥样硬化:可能引起消化不良、肠道张力减低、便秘与腹痛等症状。血栓形成时,有剧烈腹痛、腹胀和发热。肠壁坏死时,可引起便血、麻痹性肠梗阻以及休克等症状。
(七)四肢动脉粥样硬化:以下肢较为多见尤其是腿部动脉,由于血供障碍而引起下肢发凉、麻木和间歇性跛行,即行走时发生腓肠肌麻木、疼痛以至痉挛,休息后消失,再走时又出现;严重者可有持续性疼痛,下肢动脉尤其是足背动脉搏动减弱或消失。动脉管腔如完全闭塞时可产生坏疽
哪些行为会导致心脏损伤呢?心脏损伤疾病在我们日常生活中会越来越常见,我们无比在日常生活中的各种小事中注意到保护自己的心脏,我们应该如何在日常生活中保护心脏呢,以下是关于常见的会损害心脏的行为。
\n跷二郎腿 跷二郎腿的坐姿容易导致血管收缩压和舒张压分别上升7%和2%,经常跷二郎腿还会增加髋关节压力,导致腿部静脉压迫,甚至会增加血栓危险。建议大家跷二郎腿的姿势别超过10-15分钟,每坐半小时左右就应该起身走动一会儿。
\n长时间堵车 拥堵的交通很容易让人紧张、焦虑,引发血压升高。驾车时高度紧张也会促使心跳加快、心肌疲劳,容易诱发冠心病。此外,如果堵车时打开窗户,脏空气就会携带着 大量污染物迎面扑来,不仅伤害心脏,也会殃及到肺。所以研究者建议,一旦遇上交通拥堵,最好不要开窗透气,使用车内循环系统为宜。
\n常用抗菌皂 美国2013年的一项最新研究显示,三氯生是抗菌药皂和牙膏中含有的有效化学物质,它与甲状腺疾病有关,还会形成难以杀灭的、对抗生素产生抗药性的细菌,从而对心脏和肌肉组织造成损害。其实,用普通肥皂和清水洗手的效果和抗菌性药皂一样好。
\n在闹市骑车 虽然骑车是一项很好的运动,但穿行在污染严重的马路上,弊大于利。比利时哈塞尔特大学研究人员发现,无论开车、骑车或步行上班,只要经过车辆密集的路段, 都会增加心脏病发作危险,主要原因是尾气污染,其中骑车上班者危险最大。因此,建议心血管病高危人群在交通拥挤的高峰期不要选择骑车出行。
\n爱吃罐装食品 罐 装食品中含有双酚A,它是一种强效的激素干扰物,还会增加心脏病危险,即使是小剂量的双酚A(通常接触量)也会导致危险的心律失常和造成心脏性猝死的不规 则心跳。因此,除了限制罐装食品的摄入量,多吃新鲜食品或冷冻食品外,还要减少接触超市小票,因为很多小票和收据的涂层中也含有双酚A,很容易被皮肤吸 收。
\n雾霾笼罩 很多人都知道,雾霾天气对呼吸道疾病影响很大,殊不知,雾霾天气更\"伤心\"。阴霾天中的颗粒污染物不仅会引发心肌梗死,还会造成心肌缺血或损伤。
\n哪些行为会导致心脏损伤。以上是容易损伤心脏,导致疾病的一些常见行为习惯,我们大家一定要避免,需要好好保护自己的心脏,爱护自己的心脏,实现自身的健康。
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心脏穿透伤的病理和临床表现,一方面取决于受伤机制,即穿透物的性质、大小和速度。例如,火器伤所致者80%以上现场死亡,而刀刺伤约半数仍可到达医院。另一方面,主要取决于损伤的部位、伤口的大小以及心包裂口的情况。心包裂口足够大时,心脏的出血可通畅流出体外或流入胸腔、纵隔或腹腔,心包内积血(血心包)量不多,临床上主要表现为失血性休克,甚至迅速死亡。心包裂口小、或被周围组织(如心包外脂肪、肺等)或血块所堵塞,心脏出血可引起急性心包填塞,使心脏舒张受限,腔静脉回心血流受阻和心排出量减少。枪弹伤引起的心包裂口较大,主要表现为失血性休克,而刀刺伤的心包裂口容易被堵塞,80%~90%发生心包填塞。心包填塞有利于减少心脏出血,病人生存机会反而较有出血但无心包填塞者为多,然而,如不及时解除,则很快导致循环衰竭。当心脏伤口很小时可自行闭合而停止出血。左心室壁伤口容易自行封闭,心包填塞的发生率较右心室为低(42.9%对92.7%)。偶有伤后数天或数周发生迟发性心包填塞的可能性。心房壁较薄,伤口不易自然止血,可能比心室损伤更为严重。
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