心力衰尽--症状体征
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/5y9RYtGxR862ElEubBGic9ggwbmLx1V2FXibtaOlFTcwsMiaY1FckfxUUcibibnviccXMnHVcOpD18iazl5jSj0l3LDOQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">概述</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span>(heartfailure)指在静脉回流<span style="color: black;">没</span>器质性<span style="color: black;">阻碍</span>的<span style="color: black;">状况</span>下,<span style="color: black;">一般</span>是<span style="color: black;">因为</span>心肌收缩力下降<span style="color: black;">导致</span>心排血量减少，<span style="color: black;">不可</span>满足机体代谢<span style="color: black;">必须</span>的一种<span style="color: black;">综合症</span>。临床上以肺和(或)体循环淤血以及组织灌注不足为特征，又<span style="color: black;">叫作</span>充血性心力<span style="color: black;">衰尽</span>( congestive heart failure)。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/5y9RYtGxR84VrJHzMJooKleaAdwH8SdHiaT94Q8ng4WeLavxSXuLjWGqcjOHZiaN6mSJDGWfjNM8PF4dDB5un4gA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力<span style="color: black;">衰尽</span>的病因<span style="color: black;">非常多</span>,可分为心肌本身病变和心室负荷过重两大类,前者如心肌缺血、心肌坏死或心肌炎症;后者又可分为阻力负荷过重(如高血压、主动脉瓣狭窄等)和容量负荷过重(如二尖瓣或主动脉瓣关闭不全等)。心力<span style="color: black;">衰尽</span>的<span style="color: black;">出现</span>除基本病因外,常有诱发<span style="color: black;">原因</span><span style="color: black;">促进</span>其发病或使其在原有<span style="color: black;">基本</span>上病情加重,如感染、<span style="color: black;">心率</span>失常、钠盐摄人<span style="color: black;">太多</span>、输液<span style="color: black;">太多</span>和(或)过快以及过度<span style="color: black;">疲劳</span>等<span style="color: black;">增多</span>心脏负荷的多种<span style="color: black;">原因</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">症状</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">1.左心<span style="color: black;">衰尽</span></span></strong><span style="color: black;">(肺淤血)乏 力、进行性劳力性<span style="color: black;">呼气</span>困难、夜间阵发性<span style="color: black;">呼气</span>困难.端坐<span style="color: black;">呼气</span>,咳嗽、<span style="color: black;">泡泡</span>痰,<span style="color: black;">少许</span><span style="color: black;">显现</span>咯血。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2.右心<span style="color: black;">衰尽</span></span></strong><span style="color: black;">(体循环淤血)腹胀、少尿、食欲缺乏<span style="color: black;">乃至</span>恶心呕吐。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">体征</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">1.左心<span style="color: black;">衰尽</span></span></strong><span style="color: black;"><span style="color: black;">重点</span>为肺淤血的体征。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)视诊:有不同程度的<span style="color: black;">呼气</span>急促、轻微发绀、高枕卧位或端坐体位。急性肺水肿时可<span style="color: black;">显现</span>自口、鼻涌出<span style="color: black;">海量</span>粉红色<span style="color: black;">泡泡</span>,<span style="color: black;">呼气</span>窘迫,并大汗淋漓。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)触诊:严重者可<span style="color: black;">显现</span>交替脉。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(3)叩诊:除原发性心脏病体征外,<span style="color: black;">一般</span><span style="color: black;">没</span>特殊<span style="color: black;">发掘</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(4)听诊:心率增快.心尖区及其内侧可闻及舒张期奔马律，P2亢进。<span style="color: black;">按照</span>心力<span style="color: black;">衰尽</span>程度的轻重，单侧或双侧肺可闻及由肺底往上的不同程度的细小湿哕音,<span style="color: black;">亦</span>可伴少量哮鸣音;急性肺水肿时，则双肺满布湿啰音和哮鸣音。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2.右心<span style="color: black;">衰尽</span></span></strong><span style="color: black;"><span style="color: black;">重点</span>是体循环系统淤血的体征。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)视诊:颈静脉怒张.可有<span style="color: black;">周边</span>性发绀,水肿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)触诊:可触及不同程度的肝肿大、压痛及肝颈反流征阳性。下肢或腰骶部等下垂部位凹陷性水肿,严重者可全身水肿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(3)叩诊:可有胸水(右侧多见)与腹水体征。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(4)听诊:<span style="color: black;">因为</span>右心室扩大可在三尖瓣区闻及三尖瓣相对关闭不全的收缩期吹凤样杂音,以及右心室舒张期奔马律。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">除以上所列体征外，尚有原发性心脏病变和心力<span style="color: black;">衰尽</span>诱因的症状与体征。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/5y9RYtGxR861gqmNUD63ter9YdQYs7bXaoj7G7EwW09hjYMgRwvHwUe4LOBlic6RfUM9tcWezicovaQwxMGoic7fg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/5y9RYtGxR87FjBR7lDZBlEknbGBe92AI71xCbqn64nkUGvibatOK2WQTiaRusEiaDgE68dQeQgqYyP64btics1zXicA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></p><a style="color: black;"><strong style="color: blue;"><span style="color: black;">内科学</span></strong></a><a style="color: black;"><strong style="color: blue;"><span style="color: black;">症状体征</span></strong></a><a style="color: black;"><strong style="color: blue;"><span style="color: black;">儿科学</span></strong></a><a style="color: black;"><strong style="color: blue;"><span style="color: black;">实践技能</span></strong></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">外科学</strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">妇产科学</strong></span></a>
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