先天性心脏病双语.pptx
DialogueMother:My family doctor said there was cardiac murmur at the precardiac region of my little baby.She suggested that I should come here for a thorough check.Doctor:How old is your baby?Mother:About 10 months old.Doctor:Have you noticed anything wrong since he was born?Mother:He got slight cold more easily than my first son and he grows a bit slowly.Doctor:How many children do you have and how about their health conditions?Mother:I have two babies,including this one.My first is 8 years old and he is just very healthy.Doctor:Then how old are you?Mother:about 36 years old.第1页/共25页Doctor:How long ago did the family doctor find the cardiac murmur?Mother:Two weeks ago.I should have come here earlier,but I was busy with work.Doctor:Ok,I see.Now let me check him.Please lay your baby on the bed and fix his limbs.You must keep his hands off my auscultator.Doctor:I finished and you can release your hold.I found a holosystolic murmur in the area between the third and fourth ribs just on the left sternal border.I think its ventricular septal defect.Did your family doctor say so?Mother:Yes,thats what she suspected.So its true that my son has a congenital heart disease?Doctor:According to my judgment,its true.Now I am doing an ultrasound to get some details of his disease.Please hold his limbs again.Mother:Is it serious?第2页/共25页Doctor:There is a 6mm.Defect in the interventricular septum and the left atrium,right atrium,right ventricle are bigger than normal.There is a shunt from the left ventricle to the right one.Fortunately,the pulmonary artery pressure is not high.Mother:what does that mean?Doctor:The ultrasound said that your babys disease is not very serious.Dont worry so much.Mother:Is it treatable?Doctor:Surely its curable.We can give him a neoplasty and then he will be all right just like any other healthy babies.We can talk about the details if you decide to operate on him.Mother:Thanks very much.第3页/共25页Key wordsEmbryologic development of the Heart 心脏的胚胎发育The Fetal Circulation 胎儿循环Congenital Heart Disease(CHD)先天性心脏病Ventricular septal defect 室间隔缺损Atrial Septal Defect 房间隔缺损Patent Ductus Arteriosus 动脉导管未闭Tetralogy of Fallot 法洛四联症Pulmonary Stenosis 肺动脉狭窄Viral Myocarditis 病毒性心肌炎Congestive Heart Failure(CHF)充血性心力衰竭Cardiac Catheterization 心导管检查第4页/共25页1.Anatomy and Physiology of the Childhood Cardiovascular第5页/共25页Outline Embryologic Development of the HeartThe Fetal CirculationThe Transitional CirculationHeart Size,Heart Rate&Blood Pressure of Children in Different Age Groups第6页/共25页Embryologic Development of the Heart2w:开始形成原始心脏，纵直管道4w：心房和心室是共腔的，开始有循环作用8w：房室中隔完全形成，即成为具有四腔的心脏 心脏胚胎发育的关键时期是胚胎28周，在此期间如受到某些物理、化学和生物因素的影响，易引起心血管发育畸形第7页/共25页The Fetal Circulation第8页/共25页The Transitional Circulation脐带结扎脐带结扎,胎盘血循环停止胎盘血循环停止呼吸建立呼吸建立卵圆孔关闭卵圆孔关闭生后生后5 57m7m，解剖上关闭，解剖上关闭动脉导管闭缩动脉导管闭缩95%95%在在1y1y内形成解剖上关闭内形成解剖上关闭第9页/共25页Heart Size,Heart Rate&Blood Pressure of Children in Different Age Groups心脏大小和位置心脏大小和位置心胸比率：心胸比率：0.450.450.030.03心率心率血压血压65/4065/40收缩压年龄收缩压年龄X2X280mmHg80mmHgT T1 1、T T2 2：心横径，取心缘最突出部垂直于中：心横径，取心缘最突出部垂直于中线；线；T T：胸廓横径，于右膈顶取水平线达两侧：胸廓横径，于右膈顶取水平线达两侧胸廓内缘；胸廓内缘；OOOO：胸廓中线：胸廓中线第10页/共25页Congenital Heart Disease(CHD)第11页/共25页Outline OverviewEtiology Altered hemodynamics&Classification 第12页/共25页Overview The incidence of CHD in children is generally reported to be five to ten per 1,000 live births.CHD is the major cause of death(other than prematurity)in the first year of life.The etiologic factor in CHD is not known in more than 90%of cases.However,several factors are associated with a higher-than-expected incidence of the defect.第13页/共25页Etiology 内因内因外因外因宫内感染：风疹病毒感染宫内感染：风疹病毒感染射线射线代谢性疾病代谢性疾病药物影响药物影响第14页/共25页Prenatal factorsMaternal age over 40 yearsMaternal diabetes type1Maternal rubella during pregnancyMaternal alcoholismSeveral genetic factors are also implicated in CHD,although the fluency is multifactorial第15页/共25页Altered Hemodynamics&Classification Left to Right Shunt,Left to Right Shunt,Acyanotic Heart Acyanotic Heart DefectsDefectsRight to Left Shunt,Cyanotic Heart DefectsNo Shunt第16页/共25页正常血循环第17页/共25页VSDASD第18页/共25页PDATOF第19页/共25页病例1患者，男，6岁，消瘦，气短，易乏力，近年来出现青紫，既往多次患呼吸道感染，有时合并心力衰竭。体格检查：身高100cm，体重12kg，血压10/6.67kpa(75/50mmhg),营养发育差，杵状指、趾，胸骨左缘第3、4肋间可闻及三四级响亮粗糙的全收缩期杂音，并可触及收缩期震颤，肺动脉P2亢进。胸片提示：双肺纹理增多紊乱，左右心室均增大，以右心室增大为主。第20页/共25页病例2患者，男，6岁，出生后有哭闹后出现青紫，6个月时青紫逐渐明显，平时喜蹲距。哭闹后有时有突发呼吸急促、青紫加重，严重时伴晕厥。此次因同样发作急诊入院检查治疗。体格检查：T36.7c，HR 80次/分，体重13KG，口唇，指、趾甲青紫，杵状指、趾，胸骨左缘第2、3肋间可闻及三四级收缩期喷射性杂音，以第三肋最响，伴收缩期震颤，肺动脉瓣区第二音小于主动脉瓣区第二音。第21页/共25页 作为一名护士，应该解决的问题？初步诊断？主要护理问题？重点观测的并发症？治疗原则？健康指导：如何合理活动？如何饮食？第22页/共25页Key points In the fetal circulation,there are three cardiovascular structures unique to the fetus that are important for maintaining this parallel circulation:the ductus venosus,foramen ovale,and the ductus arteriosus.With the neonates first breath,gas exchange is transferred from the placenta to the lungs.The fetal shunts close,and resistance to flow in the pulmonary system decreases as systemic resistance increases.Plumonary vascular resistance decreases,and a marked increase in pulmonary blood flow follows.Treatment and prognosis of the congenital heart disease achieve great progress;several factors are associated with a higher-than-expected incidence of the defect.第23页/共25页According to the shunt direction and whether there is cyanotic,congenital heart disease could be divided into three types:left to right shunt,right to left shunt and no shunt.In left to right shunts,blood is shunted to the right side of the heart because the pressure is lower on the right side.Oxygenated and unoxygenated blood mixes.Systemic saturations are normal.第24页/共25页谢谢您的观看！第25页/共25页
