论坛 › 广东 › 咳嗽咯血险致命！竟是心脏出问题

tw4ld6 发表于 2024-6-7 23:43:48

咳嗽咯血险致命！竟是心脏出问题

<span style="color: black;">*仅供医学专业人士阅读参考</span><img src="https://mmbiz.qpic.cn/mmbiz_gif/wCGKHRs3xRsQetxiabUTF9NcQFyKrCw5lXwOs4T16iaD7IcS8kcbAZysymL5pjXxGcGibibymcXvKBoUdEepm4ugVw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/wCGKHRs3xRsQetxiabUTF9NcQFyKrCw5lZq7KjBajNzPE3LciaklwYdJRoWwuoMGwcS97jvXrDKYm2ib4GwVjkSiaA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这7种<span style="color: black;">状况</span><span style="color: black;">必要</span><span style="color: black;">认识</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;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">本例要点</span></strong></span></strong></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;">心脏病有时候表现为<span style="color: black;">呼气</span>道症状，如咳嗽、咳痰、咯血、<span style="color: black;">呼气</span>困难，容易<span style="color: black;">引起</span>误诊、漏诊。本例<span style="color: black;">病人</span>二尖瓣关闭不全的首发症状是以</span><span style="color: black;">“咳嗽、痰中带血”在<span style="color: black;">呼气</span>内科就诊，最后确诊为二尖瓣关闭不全。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">老刘今年50岁，<span style="color: black;">爱好</span>吸烟，和大部分烟民<span style="color: black;">同样</span>，平时<span style="color: black;">亦</span>偶尔咳嗽、咳痰，但最近入秋一段时间，天气转凉，昼夜温差大，咳痰比以往加重了，还伴有痰中带血。<span style="color: black;">起始</span>老刘以为是自己老慢支<span style="color: black;">爆发</span>了，没太<span style="color: black;">留意</span>。结果几天后咳嗽、痰中带血症状加重了，整口咳血痰。<span style="color: black;">显现</span>咯血症状<span style="color: black;">针对</span>老烟民而言是很害怕的，担心是肺部肿瘤。于是到医院进行胸部CT<span style="color: black;">检测</span>，结果并<span style="color: black;">无</span><span style="color: black;">发掘</span>肺部肿瘤。</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;">检测</span>不是肺癌，老刘心中的石头<span style="color: black;">亦</span>放了下来。<span style="color: black;">然则</span>CT<span style="color: black;">表示</span>双侧肺炎合并肺内<span style="color: black;">流血</span>，还是<span style="color: black;">必须</span>进行进一步<span style="color: black;">检测</span>，其中<span style="color: black;">包含</span>心脏彩超<span style="color: black;">检测</span>。老刘纳闷了，自己咳嗽是肺的问题，怎么会<span style="color: black;">检测</span>心脏呢？其实，咳嗽除了是<span style="color: black;">呼气</span>系统<span style="color: black;">疾患</span>的表现，<span style="color: black;">亦</span>可能是心血管<span style="color: black;">疾患</span>的临床症状。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">咳嗽可能与<span style="color: black;">那些</span>心血管病<span style="color: black;">相关</span></strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">▎</strong><strong style="color: blue;">（1）先心病</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在儿科门诊，<span style="color: black;">非常多</span><span style="color: black;">状况</span>下先心病患儿首诊不会是看心脏问题，而是看咳嗽。<span style="color: black;">由于</span>一方面<span style="color: black;">孩儿</span>太小没办法表达心脏不适的症状，另一方面先心病本身就表现为反复<span style="color: black;">爆发</span>的咳嗽，<span style="color: black;">乃至</span>肺炎。<span style="color: black;">因此呢</span>，儿科<span style="color: black;">大夫</span>在诊断和治疗儿童上<span style="color: black;">呼气</span>道感染的时候，别忘记<span style="color: black;">检测</span>心脏<span style="color: black;">可否</span>有问题。</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;">▎</strong><strong style="color: blue;">（2）瓣膜病</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">人体心脏里有4个瓣膜，其中二尖瓣与肺循环密切<span style="color: black;">关联</span>，当任何<span style="color: black;">状况</span><span style="color: black;">导致</span>二尖瓣病变时，都可能<span style="color: black;">导致</span>肺循环淤血的改变，从而<span style="color: black;">显现</span>咳嗽症状。</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;">▎</strong><strong style="color: blue;">（3）心脏肿瘤</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心脏肿瘤容易<span style="color: black;">显现</span>肿瘤随心脏跳动，进进出出瓣膜口，<span style="color: black;">倘若</span>影响二尖瓣，<span style="color: black;">能够</span><span style="color: black;">引起</span>肺瘀血，从而<span style="color: black;">显现</span>咳嗽症状。</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;"><strong style="color: blue;">▎</strong>（4）心衰</span></strong></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;">各样</span>病因<span style="color: black;">引起</span>的心衰，都<span style="color: black;">能够</span><span style="color: black;">显现</span>咳嗽、咳痰、<span style="color: black;">乃至</span>咳粉红色<span style="color: black;">泡泡</span>样痰的症状，<span style="color: black;">同期</span>伴有心衰的临床表现，如<span style="color: black;">不可</span>平卧、双下肢水肿等。</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;"><strong style="color: blue;">▎</strong>（5）心包<span style="color: black;">疾患</span></span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心包<span style="color: black;">疾患</span><span style="color: black;">病人</span>部分<span style="color: black;">亦</span>可<span style="color: black;">显现</span>咳嗽症状。</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;"><strong style="color: blue;">▎</strong>（6）主动脉<span style="color: black;">疾患</span></span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">慢性主动脉夹层动脉瘤，<span style="color: black;">因为</span>瘤体大压迫肺组织<span style="color: black;">导致</span>咳嗽、胸闷等症状。当夹层动脉瘤进一步增大，<span style="color: black;">乃至</span>有破裂<span style="color: black;">流血</span>趋势的时候，<span style="color: black;">乃至</span>可能<span style="color: black;">显现</span>咯血症状。这种<span style="color: black;">状况</span>下<span style="color: black;">倘若</span><span style="color: black;">呼气</span>科<span style="color: black;">大夫</span><span style="color: black;">无</span><span style="color: black;">即时</span><span style="color: black;">发掘</span>主动脉<span style="color: black;">疾患</span>，<span style="color: black;">乃至</span>可能<span style="color: black;">引起</span><span style="color: black;">劫难</span>性后果。</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;"><strong style="color: blue;">▎</strong>（7）心血管<span style="color: black;">药品</span><span style="color: black;">关联</span>咳嗽</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心血管病人平时<span style="color: black;">运用</span><span style="color: black;">药品</span>品种繁多，有部分心血管<span style="color: black;">药品</span>可能<span style="color: black;">导致</span>咳嗽，最<span style="color: black;">平常</span>的为降压<span style="color: black;">药品</span>血管紧张素转化酶<span style="color: black;">控制</span>剂，容易<span style="color: black;">导致</span>夜间刺激性干咳。<span style="color: black;">因此呢</span>在接诊咳嗽<span style="color: black;">病人</span>时，<span style="color: black;">必定</span>要仔细询问病人的服药<span style="color: black;">药品</span>病史。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">果不其然，老刘的心脏彩超结果真的是心脏病，<span style="color: black;">况且</span>还是严重的二尖瓣重度关闭不全。为<span style="color: black;">认识</span>除老刘心中的疑惑，<span style="color: black;">大夫</span>进行了科普。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">什么是二尖瓣关闭不全</strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">人体心脏有四个瓣膜，瓣膜的正常开合维持心脏生理性正向血液流动方向。当某个心脏瓣膜<span style="color: black;">显现</span>关闭不全时，会<span style="color: black;">引起</span>反向血流，严重者<span style="color: black;">显现</span>血流动力学<span style="color: black;">错乱</span>。</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3v20LtranD8tQ2DhCpSVlWlwx5Op3T5aiaZ4eicj4kzaSsz7GI926QnQCA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图1 心脏及瓣膜示意图</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">二尖瓣关闭不全是<span style="color: black;">因为</span>二尖瓣的<span style="color: black;">自己</span>结构组织发<span style="color: black;">患病</span>变，<span style="color: black;">引起</span>在左心室收缩过程中，<span style="color: black;">没</span>法完全闭合，<span style="color: black;">导致</span>血液反向流入左心房，使左心房负荷和左心室舒张期负荷<span style="color: black;">增多</span>，从而<span style="color: black;">导致</span>一系列血流动力学变化。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">二尖瓣关闭不全的病因</strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、瓣叶受损。风湿性心脏瓣膜病<span style="color: black;">导致</span>的免疫反应<span style="color: black;">引起</span>瓣叶增厚、粘连、融合，<span style="color: black;">或</span>感染性心内膜炎<span style="color: black;">引起</span>瓣叶穿孔，结果都<span style="color: black;">引起</span>瓣叶生理形态<span style="color: black;">出现</span>改变，影响瓣膜关闭而<span style="color: black;">导致</span>关闭不全。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2、瓣环扩大。任何病因<span style="color: black;">导致</span>左心室增大<span style="color: black;">或</span>二尖瓣环退行性变和瓣环钙化均可<span style="color: black;">导致</span>二尖瓣环扩大而<span style="color: black;">引起</span>二尖瓣关闭不全。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3、腱索受损。先天性腱索<span style="color: black;">反常</span>、自发性断裂或继发于感染性心内膜炎、风湿热的腱索断裂均可<span style="color: black;">引起</span>二尖瓣关闭不全。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、乳头肌受损。乳头肌短暂性缺血可<span style="color: black;">显现</span>短暂的二尖瓣关闭不全；如急性心肌梗死<span style="color: black;">引起</span>乳头肌缺血坏死，则产生永久性二尖瓣关闭不全。</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;">因此呢</span>，临床上<span style="color: black;">显现</span>二尖瓣关闭不全时，应该结合<span style="color: black;">病人</span><span style="color: black;">详细</span>病情寻找可能的病因。如<span style="color: black;">青年</span><span style="color: black;">病人</span>多<span style="color: black;">思虑</span>为先天性腱索<span style="color: black;">反常</span>、自发性断裂或感染性心内膜炎<span style="color: black;">引起</span>的瓣叶及腱索病变；年老<span style="color: black;">病人</span>多<span style="color: black;">思虑</span>为退行性变，风湿性心脏瓣膜病<span style="color: black;">一般</span><span style="color: black;">引起</span>二尖瓣狭窄合并关闭不全。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">二尖瓣关闭不全的临床症状</strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">按照</span>二尖瓣关闭不全的程度（轻—中—重度）、急性或慢性、心脏代偿<span style="color: black;">状况</span>及<span style="color: black;">可否</span>合并其它心脏病变，临床表现不尽相同。二尖瓣关闭不全的典型症状是左心衰和右心衰表现，即劳力性<span style="color: black;">呼气</span>困难、夜间阵发性<span style="color: black;">呼气</span>困难、肝脏淤血肿大、腹腔积液、腹胀、下肢水肿等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性二尖瓣关闭不全可<span style="color: black;">快速</span>表现肺淤血及急性肺水肿症状，如咳嗽咯血、<span style="color: black;">呼气</span>困难，严重者<span style="color: black;">必须</span><span style="color: black;">呼气</span>机<span style="color: black;">乃至</span>ECMO维持<span style="color: black;">呼气</span>循环稳定（参见“郑儿八经说心事”病例12及病例38）。而慢性二尖瓣关闭不全代偿期较长，<span style="color: black;">显现</span>症状较晚。<span style="color: black;">针对</span>合并冠状动脉<span style="color: black;">疾患</span>的缺血性二尖瓣关闭不全病人，可<span style="color: black;">显现</span>心绞痛的临床症状。慢性二尖瓣轻至中度关闭不全<span style="color: black;">亦</span>可<span style="color: black;">长时间</span><span style="color: black;">没</span><span style="color: black;">显著</span>临床症状。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本例<span style="color: black;">病人</span>就<span style="color: black;">显现</span>了二尖瓣关闭不全<span style="color: black;">引起</span>的肺水肿症状。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">二尖瓣关闭不全的并发症</strong></span></strong></span><span style="color: black;"><strong style="color: blue;">一</strong></span><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">心率</span>失常（房颤）</strong></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">慢性二尖瓣关闭不全，<span style="color: black;">海量</span>血流反流至左房，<span style="color: black;">导致</span>左房负荷过重、左房增大，部分<span style="color: black;">病人</span><span style="color: black;">能够</span>诱发房颤<span style="color: black;">出现</span>。</span></p><span style="color: black;"><strong style="color: blue;">二</strong></span><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;">感染性心内膜炎</strong></strong></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">长时间</span>存在未<span style="color: black;">纠正</span>的二尖瓣关闭不全，<span style="color: black;">尤其</span>是<span style="color: black;">因为</span>瓣叶脱垂或腱索断裂<span style="color: black;">导致</span>的二尖瓣关闭不全，在菌血症<span style="color: black;">出现</span>的时候容易<span style="color: black;">导致</span>细菌在本身存在病变的二尖瓣聚集，形成细菌团从而<span style="color: black;">引起</span>感染性心内膜炎<span style="color: black;">出现</span>，而后者<span style="color: black;">同期</span>加重瓣膜关闭不全。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">部分二尖瓣关闭不全合并感染性心内膜炎患者，赘生物脱落<span style="color: black;">引起</span>中枢或外周动脉栓塞，<span style="color: black;">显现</span>相应脑梗及外周动脉栓塞的临床症状（图2~4）。</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3vw47y5gp9aGHFgsqiaAJ5MOjOyiahuLyGx44kfEdl4YOvIkib2ZCntzomA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图2 心脏彩超<span style="color: black;">表示</span>二尖瓣赘生物（红箭头所示）</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3vZz3xULWBwWlicrxs2Jc7u9Wv6DJicc71sLyIjOC067ibO3BuzHLO8V9aQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图3 头部CT<span style="color: black;">表示</span>右侧脑梗合并少量<span style="color: black;">流血</span>（红箭头所示）</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3vcILNjMlF8O6FSua3hOyN9jBO8IiadxO2WmQbiavAO9HwgS8BnY0tzLvA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图4 下肢动脉CTA<span style="color: black;">表示</span>左股动脉栓塞，远端不显影。</span></p><span style="color: black;"><strong style="color: blue;">三</strong></span><span style="color: black;"><strong style="color: blue;">心力衰竭</strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭是所有类型心脏病发展到终末期的转归。当慢性二尖瓣关闭不全较<span style="color: black;">长期</span>，会<span style="color: black;">导致</span>心腔扩大（图5），进一步<span style="color: black;">发展</span><span style="color: black;">最后</span><span style="color: black;">引起</span>全心扩大，<span style="color: black;">从而</span><span style="color: black;">显现</span>心力衰竭。</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3v1Q3uA4czicfvSlVFHIn2F6fvxAv1rFJ7BlQAwUMUSIx7dh6QjK5o4dQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图5 二尖瓣关闭不全<span style="color: black;">病人</span>术前胸片<span style="color: black;">表示</span>心影增大，心脏彩超<span style="color: black;">表示</span>左房扩大（77cm），左室扩大（78cm）。</span></p><span style="color: black;"><strong style="color: blue;">四</strong></span><span style="color: black;"><strong style="color: blue;">肺部并发症</strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如本例<span style="color: black;">病人</span>，二尖瓣关闭不全容易<span style="color: black;">显现</span>肺部并发症，严重者<span style="color: black;">显现</span>肺水肿，<span style="color: black;">呼气</span>困难，<span style="color: black;">乃至</span><span style="color: black;">必须</span>机械通气或ECMO治疗（图6）</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/YvFeD6T0icibLoPyUgaUa7hnXM00JC7a3vanyLJH0doWMm5o0Tibz31TYHtqIPocx3tov8p6Z9Pia2ROgUoeVMWdHg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;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;">图6 胸片及胸部CT<span style="color: black;">表示</span>肺水肿（红箭头所示）</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">二尖瓣关闭不全的<span style="color: black;">检测</span></strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当临床症状和体征（心前区可闻及收缩期杂音）提示二尖瓣病变时，心脏彩超<span style="color: black;">重点</span><span style="color: black;">评定</span>心腔结构及<span style="color: black;">体积</span>、瓣膜<span style="color: black;">状况</span>及开合<span style="color: black;">情况</span>、血流<span style="color: black;">经过</span>瓣膜<span style="color: black;">情况</span>，<span style="color: black;">可否</span>存在赘生物、心脏收缩及舒张功能，是心脏瓣膜<span style="color: black;">疾患</span>最<span style="color: black;">要紧</span>的<span style="color: black;">检测</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心电图<span style="color: black;">亦</span>是<span style="color: black;">评定</span>的<span style="color: black;">要紧</span><span style="color: black;">检测</span>，主要看<span style="color: black;">可否</span>合并<span style="color: black;">心率</span>失常。针对二尖瓣关闭不全的不同病因，如感染性心内膜炎<span style="color: black;">引起</span>的二尖瓣关闭不全，在未<span style="color: black;">运用</span>抗生素前最好行血培养<span style="color: black;">检测</span>，<span style="color: black;">知道</span>病菌类型。再如缺血性二尖瓣关闭不全，应该行冠脉造影<span style="color: black;">评定</span>冠脉<span style="color: black;">状况</span>。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">二尖瓣关闭不全的治疗</strong></span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">二尖瓣关闭不全的治疗<span style="color: black;">按照</span>以下<span style="color: black;">原因</span>综合<span style="color: black;">思虑</span>决定治疗<span style="color: black;">方法</span>：不同病因、关闭不全的程度（轻—中—重度）、急性或慢性、心脏代偿<span style="color: black;">状况</span>及<span style="color: black;">可否</span>合并其它心脏病变等等。<span style="color: black;">详细</span>治疗<span style="color: black;">方法</span><span style="color: black;">包含</span><span style="color: black;">药品</span>保守治疗、外科手术治疗及<span style="color: black;">近期</span>发展的微创经导管二尖瓣手术。</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;">针对</span><span style="color: black;">没</span>临床症状<span style="color: black;">或</span>临床症状轻微者，轻到中度关闭不全，心脏<span style="color: black;">体积</span>变化不大，可<span style="color: black;">思虑</span>随访观察，避免以上并发症<span style="color: black;">出现</span>而<span style="color: black;">引起</span>病情加重。<span style="color: black;">针对</span>慢性退行性病变<span style="color: black;">病人</span>，<span style="color: black;">按照</span><span style="color: black;">详细</span>病情<span style="color: black;">选取</span><span style="color: black;">药品</span>治疗还是手术治疗或微创经导管二尖瓣手术。<span style="color: black;">针对</span>感染性心内膜炎<span style="color: black;">引起</span>的二尖瓣关闭不全，应积极手术治疗。<span style="color: black;">针对</span>缺血性二尖瓣关闭不全合并冠心病<span style="color: black;">病人</span>，<span style="color: black;">评定</span>心功能能否耐受手术<span style="color: black;">状况</span>，决定<span style="color: black;">可否</span>外科手术治疗还是<span style="color: black;">药品</span>治疗。外科手术治疗方式<span style="color: black;">包含</span>瓣膜修复和瓣膜替换，由<span style="color: black;">大夫</span><span style="color: black;">按照</span>不同病情<span style="color: black;">选取</span>。</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">总结</span></strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（1）咳嗽症状可能与心血管<span style="color: black;">疾患</span><span style="color: black;">关联</span>；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（2）二尖瓣关闭不全临床症状多样化，及早<span style="color: black;">知道</span>诊断很<span style="color: black;">要紧</span>；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（3）<span style="color: black;">导致</span>二尖瓣关闭不全的病因有<span style="color: black;">非常多</span>种；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（4）二尖瓣关闭不全可能<span style="color: black;">导致</span>全身并发症；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（5）<span style="color: black;">按照</span><span style="color: black;">详细</span>病情决定二尖瓣关闭不全的治疗<span style="color: black;">方法</span>。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/wCGKHRs3xRsQetxiabUTF9NcQFyKrCw5lZq7KjBajNzPE3LciaklwYdJRoWwuoMGwcS97jvXrDKYm2ib4GwVjkSiaA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/wCGKHRs3xRulKEpdIBVS67YhIAHRNHRB7Lic2NStxVtrnj2Gibd6gdjTXgic4wu9wKyTEmn2MtuE1YFxbydHF6r6w/640?wx_fmt=gif&amp;wxfrom=5&amp;wx_lazy=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;"></span><span style="color: black;">本文首发：医学界心血管频道</span><span style="color: black;">本文作者：郑智</span>
    <h3 style="color: black; text-align: left; margin-bottom: 10px;">
      <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/wCGKHRs3xRulKEpdIBVS67YhIAHRNHRB7Lic2NStxVtrnj2Gibd6gdjTXgic4wu9wKyTEmn2MtuE1YFxbydHF6r6w/640?wx_fmt=gif&amp;wxfrom=5&amp;wx_lazy=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;"></p>
    </h3>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">不想<span style="color: black;">错失</span></span><span style="color: black;"><strong style="color: blue;">心脏之声</strong></span><span style="color: black;">的推送？</span></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;">戳<span style="color: black;">文案</span>顶部蓝字“</span><span style="color: black;">哈特瑞姆心脏之声</span><span style="color: black;">”关注<span style="color: black;">咱们</span></span></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;">并点击右上角<strong style="color: blue;">“···”</strong>菜单，<span style="color: black;">选取</span></span><span style="color: black;"><strong style="color: blue;">“设为星标”</strong></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;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/wCGKHRs3xRulKEpdIBVS67YhIAHRNHRB7Lic2NStxVtrnj2Gibd6gdjTXgic4wu9wKyTEmn2MtuE1YFxbydHF6r6w/640?wx_fmt=gif&amp;wxfrom=5&amp;wx_lazy=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;"></strong></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/wCGKHRs3xRv2K1NdP2iaNWGXUrEuSVoPKicqcC25QFribTyfzgKcb36yNSVlOhmLPoMxoqv0u3N6B9bxI6nEgDKDg/640?wx_fmt=jpeg&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;"></p>

4zhvml8 发表于 2024-10-2 06:29:05

一看到楼主的气势，我就觉得楼主同在社区里灌水。

4zhvml8 发表于 2024-10-3 23:27:42

大势所趋，用于讽刺一些制作目的就是为了跟风玩梗，博取眼球的作品。

m5k1umn 发表于 2024-10-16 04:23:04

谷歌外贸网站优化技术。

m5k1umn 发表于 2024-11-10 16:20:27

i免费外链发布平台 http://www.fok120.com/

b1gc8v 发表于 2024-11-14 05:23:55

我完全同意你的观点，说得太对了。

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