2022年医学专题—查房-低心排.pptx

LowCardiacOutputSyndrome低心排综合征SICU-1第一页，共二十四页。LowCardiacOutputSyndrome低心排综合征(LowCardiacOutputSyndrome，LCOS)，简称低心排，是心脏外科最严重的生理异常，正常人的心排出(páichū)量按每平方米面积计算，也就是心指数为3-4L/(min·m2)，如心指数降低至3L/(min·m2)以下而有周围血管收缩，组织灌注不足的现象，称为低心排出量综合征。第二页，共二十四页。1Casesintroductioncontents2causesofLCOS3clinicalmanifestations4Treatments5observingandnursingcare第三页，共二十四页。CasesintroductionName:ZhuChangyin姓名：祝长银性别：男Gender:MaleAge:59年龄：59岁Admissiontime:2017-08-06入院(rùyuàn)时间：2017-Operationtime:2017-08-17Maincomplaint:chesttightness,08-06手术时间：2017-08-17wheezefor4months主诉：胸闷、憋喘4月余第四页，共二十四页。CasesintroductionDiagnosis:诊断(zhěnduàn)：heartvalvestenosis,主动脉瓣狭窄三尖瓣返流tricuspidregurgitation手术名称：Operation:主动脉瓣置换术aorticvalvereplacement第五页，共二十四页。Historyofpresentillness现病史(bìnɡshǐ)chesttightness胸闷,suppressasthma憋喘,cough咳嗽,sputum咳痰,withoutsignificantfactorsinAprilthisyeardiagnosis:pleuraleffusion,Afworse,nightorthopnea夜间(yèjiān)端坐呼吸,cannotlaydown.diagnosedwithheartvalvedisease.admittedtotheclinicwith"valvulardisease".第六页，共二十四页。pasthistory既往(jìwǎnɡ)史Diabetes（糖尿病）historyfor2years.Paroxysmalatrialfibrillation（阵发性房颤）for4months.第七页，共二十四页。Postoperativelowcardiacperformance术后低心排表现(biǎoxiàn)theoxygensaturationreducedfrom98to88.CVP11-12，slowlyroseto21-22Bloodpressureisdownfrom130-140/80to110/70nourineatthesametimeHeartcolorultrasoundrevealed:noeffusionofpericardialfluid,asmallamountoffluidintherightsideofthethoraciccavity,theleftventricularwallmovinglower,EF38第八页，共二十四页。causesofLCOS低心排的原因(1)(yuányīn)Pulmonaryhypertension肺动脉高压(gāoyā)Arhythmiaunsuccessful心律失常shīchánɡ)(xīnlǜcorrectionofcardiaccardiacmalformationinsufficiency心脏畸形矫心功能差正不良第九页，共二十四页。causesofLCOS低心排的原因(2)(yuányīn)Hypovolemiapericardialtamponade血容量(róngliàng)不足心包填塞cardiaccontractile第十页，共二十四页。Coronaryaeroembolismdysfunction---cardialinfarction心肌(xīnjī)收缩不全冠脉气栓—心梗patho-physiologicchange病理生理变化(bìnglǐ)主动脉阻断无氧能量生Na泵功代谢成减少(zǔduàn)(dàixiè)增能障碍加乳酸增多细胞酸中毒复灌心肌水肿，内膜下出血第十一页，共二十四页。clinicalmanifestations临床表现tachycardiaMindchange心动过速神志(shénzhì)变化Fastandshallowpalecomplexion,breathingColdlimbs呼吸(hūxī)浅快面色苍白、四肢(sìzhī)湿冷第十二页，共二十四页。Monitoringindicators监护(jiānhù)指标BPEarlybloodpressuredoesnotnecessarilydecrease,andoncelowbloodpressureisshown,theconditionissevereCVPDifferentialdiagnosisforpatientswithlowcardiacsyndromeABGPaO2decreased,standardbicarbonateandPH血气分析decreasedthemostsensitiveindicationUrineVolume尿量第十三页，共二十四页。Treatments治疗(1)(zhìliáo)保证前负荷Dopamine:5-10μg/kg/min的情况下若>10μg/kg/min收缩肾脏(shènzàng)血血压低，可选用增强心管肌(xīnjī)收缩力的药物。Epinephrine：正性肌力，收缩全身血管，关注尿Noradrenaline：增加外周阻力第十四页，共二十四页。Treatments治疗(2)(zhìliáo)ArythmiaSVT(室上速)：心律失常(xīnlǜshīchánɡ)西地兰：正性肌力减慢心率注意(zhùyì)钾与钙Af(房颤)：可达龙：常见心动过缓Bradycardia(心动过缓)：异丙肾上腺素临时起搏器...