資源描述：
《外科治療的心血管疾病.ppt》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在PPT專區(qū)-天天文庫(kù)。
1、外科治療的心血管疾病心外科DeptofCardiovascularSurgery席振山教授ProfessorXiZhenshan一、先天性心臟病Congenitalheartdiseases1肺動(dòng)脈狹窄(pulmonarystenosis)震顫(tremor)、雜音(murmur)：L2、SM、P2↓X線片(X-ray)：肺血少、右心大、肺動(dòng)脈窄后擴(kuò)張心電圖(ECG)：肺型P、電軸右偏、右室肥大超聲心動(dòng)圖(Echocardiography)心導(dǎo)管和心血管造影(cardiaccatheterizati
2、onandcardioangiography)CT的MRI顯示肺動(dòng)脈及其分支治療(treatment)閉式肺動(dòng)脈瓣切開(closedpulmonaryvalvulotomy)直視肺動(dòng)脈瓣切開(pulmonaryvalvulotomyunderdirectvision)常溫或低溫體外循環(huán)流出道梗阻解除2動(dòng)脈導(dǎo)管未閉(PatentDuctusArteriosus)舉例：動(dòng)脈導(dǎo)管未閉(PDA)病理解剖(pathologicoanatomic)（圖2）血流動(dòng)力學(xué)(hemodynamics)和臨床表現(xiàn)分流量(
3、shuntvolume)的多少取決：主-肺動(dòng)脈壓力差大小導(dǎo)管直徑粗細(xì)肺血管阻力高低震顫(tremor)雜音(murmur)心電(ECG)X線片(X-ray)超聲心動(dòng)圖(echocardiography)心導(dǎo)管及心血管造影(cardiaccatheterizationandcardioangiography)治療(treatment)導(dǎo)管結(jié)扎(ductusligation)導(dǎo)管切斷(ductusamputation)體外導(dǎo)管縫合(suture)胸腔鏡導(dǎo)管閉合導(dǎo)管阻塞3房間隔缺損(AtrialSepta
4、lDefect)舉例：房間隔缺損(ASD)病理解剖特點(diǎn)(pathologicoanatomic)（圖3）血流動(dòng)力學(xué)(hemodynamics)和臨床表現(xiàn)癥狀(signs)雜音(murmur)：L2、SM、P2↑X線片(X-ray)心電圖(ECG)超聲心動(dòng)圖(echocardiography)心導(dǎo)管及心血管造影(cardiaccatheterizationandcardioangiography)治療低溫阻斷房間隔縫合深低溫停循環(huán)房間隔修補(bǔ)體外循環(huán)房間隔缺損修補(bǔ)房間隔傘修補(bǔ)術(shù)4室間隔缺損(Ventri
5、cularSeptalDefect)病理解剖特點(diǎn)(pathologicoanatomic)（圖4）血流動(dòng)力學(xué)(hemodynamics)和臨床表現(xiàn)震顫(tremor)、雜音(murmur)：L3、4SMX線片(X-ray)心電圖(ECG)超聲心動(dòng)圖(echocardiography)心導(dǎo)管及心血管造影(cardiaccatheterizationandcardioangiography)治療深低溫停循環(huán)室間隔缺損修補(bǔ)術(shù)體外循環(huán)室間隔缺損修補(bǔ)術(shù)5法魯氏四聯(lián)癥(TetralogyofFallot)病理解
6、剖特點(diǎn)(pathologicoanatomic)（圖5）血流動(dòng)力學(xué)(hemodynamics)和臨床表現(xiàn)右向左分流杵狀指（趾）clubbedfinger(toe)紫紺(cyanosis)雜音(murmur)X線片(X-ray)心電圖(ECG)超聲心動(dòng)圖(echocardiography)化驗(yàn)檢查(laboratoryfindings)心導(dǎo)管及心血管造影(cardiaccatheterizationandcardioangiography)治療分流術(shù)深低溫停循環(huán)體外循環(huán)二、后天性心臟病Acquired
7、HeartDiseases（一）心包炎(pericarditis)1．急性化膿性心包炎(acutepurulentpericarditis)2．慢性縮窄性心包炎(chronicconstrictivepericarditis)（二）風(fēng)濕性心臟病1．風(fēng)濕性二尖瓣狹窄(rheumaticmitralstenosis)2．風(fēng)濕性二尖瓣關(guān)閉不全(rheumaticmitralinsufficiency)3．主動(dòng)脈瓣狹窄(aorticstenosis)4．主動(dòng)脈瓣關(guān)閉不全(aorticinsufficienc
8、y)5．聯(lián)合瓣膜病6．三尖瓣病變(tricuspiddiseases)（三）冠狀動(dòng)脈硬化性心臟病(CoronaryHeartDisease)1．左主干狹窄≥50%2．三支以上血管明顯狹窄≥70%3．單支以上還有前降支嚴(yán)重狹窄≥90%4．心肌梗死后并發(fā)癥(complicationsofmyocardialinfarction)⑴室間隔穿孔(perforationofinterventricularseptum)⑵乳頭肌、腱索斷裂(ruptureofpapillarymu
