重癥肺動(dòng)脈高壓致急性右心功能不全-資料下載頁
2025-09-19 08:54本頁面
【導(dǎo)讀】患者于7天前開始無明顯誘因出現(xiàn)發(fā)熱，體溫驟然升高在39. 攝氏度以上，最高達(dá)41攝氏度。持續(xù)數(shù)小時(shí)后能自行緩解，以夜間明顯，并陣發(fā)性咳嗽，以干咳為主，無痰，無咯血，胸痛、胸悶，無惡心、嘔吐，無關(guān)節(jié)疼痛，感活動(dòng)后氣促，經(jīng)休息后能逐漸緩解，無夜間陣發(fā)性呼吸困難及端坐呼吸，來我院就診，收入我科?；颊咂鸩∫詠?，精神食欲欠佳，大小便尚可，睡眠欠佳。否認(rèn)“高血壓”病史，否認(rèn)“肝炎”“結(jié)。過敏史，預(yù)防接種史不詳。個(gè)人史、婚育史、家族史無特殊。尚清，體查合作，急性重病容，半坐位。皮膚無出血點(diǎn)，皮膚彈性可。全身淺表淋巴結(jié)無腫大。大小無畸形，結(jié)膜無充血，雙瞳孔等大等圓，對(duì)光反射靈敏。鼻翼無煽動(dòng)，口唇無發(fā)紺，咽無充血，扁桃體不大。頸軟，頸靜脈充盈，頸動(dòng)脈搏動(dòng)可，未聞及明顯血管雜音。陰性，雙側(cè)腎區(qū)無叩擊，腸鳴音4次/分。肛門外生殖器未見明顯。脊柱四肢無畸形，雙下肢無水腫，生理反射可，病理征未
【正文】 ytmias ? Infections ? Pulmonary embolism ? Thyro239。d dysfunction Optimization of preload FrankStarling relationship between preload and stroke volume: preload dependance (A) and preload independance (B) Fluid therapy Diuretics ? Frequent volume overload ? At a point of FrankStarling curve where there is no more reserve on contractility ? Ventricular interdependance ? Diuretics to be considered ? Sometimes with continuous high dose infusion ? Prospective, controlled, randomized, animal study ? 22 dogs underwent transient PA constriction (90mn) ? Dobutamine 5 and 10 ?g/kg/mn, norepinephrine to ?g/kg/mn ? A transient increase in PA pressure persistently worsens PA hemodynamics, RV contractility, RVPA coupling, and cardiac output. ? Dobutamine restores RVPA coupling and cardiac output better than norepinephrine because of its more pronounced inotropic effect Dobutamine ? ?1 adrenergic stimulation ? ? CI ? PVR at 5 ?g/kg/mn ? At higher dose ? HR without subsequent ? in PVR ? Experimental models Dobutamine Norepinephrine to improve rightventricular – pulmonary artery coupling ? Improves CI, PVR and PaO2/FiO2 in bination with Inhaled nitric oxyde Norepinephrine ? ? 1 and ?1 adrenergic stimulation ? Increases mPAP and PVR ? But marked improvement in CO ? Useful in bination with Dobutamine for hypotensive patients ? Causes less tachycardia than other inotropes ? Second choice after Dobutamine in normotensive patients Pulmonary vasodilators 肺動(dòng)脈血管擴(kuò)張劑 目前臨床上應(yīng)用的血管擴(kuò)張劑有： ? 前列環(huán)素 ? 吸入 NO ? 內(nèi)皮素受體拮抗劑 ? 5型磷酸二酯酶抑制劑 ? Rho激酶抑制劑。 Haddad F, MD。 Circulation. 2020。117:17171731 Thank you for attention !
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