Lung the intersection of artery and high-pressure norm could diagnose _'s general knowledge effectively

Lung the intersection of artery and high-pressure norm could diagnose _'s general knowledge effectively
Artery high pressure of lung (PAH) It mean it is caused by various reasons lung blood vessel bed structure and ( Or) The change of the function, cause and rise for the clinical syndrome of the characteristic with the blood vessel resistance of lung. Its cause of disease is complicated, diagnoses that it is the main reason that this field is developed to treat thornily slowly. In the western countries, because of the progress of studying, PAH has already become a major kind of cardiovascular vessel disease paid attention to gradually. Our publication specially puts out PAH special edition, in order to further promote the development of PAH of our country.
Artery high pressure of lung (PAH) Just is divided two kinds into primarily and continues taking place PAH briefly in the past.
With mechanism, pathology and constant deepening and clinical and therapeutic actual need that the pathologic physiology realizes to PAH, World Health Organization (WHO) Revised the classifying of PAH to 1998 again on the basis that PAH which France announced classified in Venice of Italy in 2003. Divide PAH into five major kinds: (1)(artery type) PAH; (2)High pressure of pulmonary vein; (3)Respiratory disease and ( Or) PAH that the hypoxia caused; (4)Chronic thrombus thromboembolism PAH; (5)The mixed factor causes.
The greatest characteristic classified newly cancels continuing to use primary PAH for many years and diagnosing terms, two kinds instead of specially sending and family PAH. The reason of the former is still unidentified, the latter is due to gene mutation with already bright reason.
The clinical manifestation difference is obvious
Different kinds of PAH because basic causes of disease are different, its clinical manifestation is different, but when developing into prominent PAH in condition, often with following similar symptoms and physical sign.
It is the most common symptom that the labour of symptom has difficulty in breathing, secondly it is weak, palpitation, chest aching, spitting blood, fainting and hoarseness uncomfortable in chest,etc..
Physical sign mainly has respiratory rate that increases, the heart rate is quick, cyanosis, the poke is pointed (toe) ,Lung blood vessel noise, lung artery systolic phase beats between left second rib, lung artery is a second sound ( P2) of district Hyperfunction, the systolic phase backflow noise of tricuspid valve. When it is depleted that the right heart happens can appear corresponding physical sign, neck vein full of, beat, the intersection of liver and increasing, ascites, edema around,etc..
Auxiliary examination is essential
The electrocardiogram is mainly shown as sinus tachycardia, the increase or plump of the atrium dextrum, room, lung type P wave, the right of electric axle leans towards, 2, aVF and right chest lead the way and unite ST-T to change.
Chest flat in X-ray block under right lung harsh and unreasonable to wide directly in artery,lung section is outstanding artery, lung and is laminations peripheral very thin to last distinct contrast or last " the roots incomplete " door arteriectasis ,The atrium dextrum, room are expanded.
Supersound aroused in interest to pursue, can screen the function obstacle and inborn or continue sending valve disease of left ventricle while being aroused in interest to pursue by supersound, it is a kind of good screening test. But quantitative to determine right the intersection of room and pressure, estimate, examine the intersection of lung and the intersection of artery and the intersection of pressure and competence. Determine left and right rooms big or small right room plump closing completely by the intersection of interventricular septum and the intersection of contradiction and sport and lung artery one and tricuspid valve.
The lung function is determined besides observing that there is obstructive lung that keeps in touch with the function obstacle with the analysis of artery vim and vigour, still need to pay special attention to keeping in touch with function obstacle and disperse function obstacle restrictedly, thus find rooms of quality pulmonary tuberculosis, the intersection of connective tissue and the intersection of disease and the intersection of relevance and PAH, chronic pulmonary embolism or backbone, pleura and breathe skin PAH that disease cause. The analysis of artery vim and vigour also needs to pay attention to the change of PaCO2 besides hypoxemia disease, PaCO2 drops to usually reflect oxygen deficiency is excessively kept in touch with, often cause breath alkalemia, make the condition complicate. The explanation of the change of vim and vigour needs to combine closely clinically, judge synthetically.
The nuclide lung is kept in touch with poured into and scanned to judge dailily whether there is thromboembolism PAH, if the result is normal, without chronic pulmonary embolism, the more possible ones are specially sending or other types PAH.
The computer takes a photograph of (CT) body layer Including strengthening CT, high-resolution CT, checks, although can't verify directly whether there is PAH in magnetic resonance,etc., but can help reason and basic disease of clear PAH, such as congenital heart disease, it is myocardium disease, pulmonary embolism, among quality pulmonary tuberculosis, lung inflammation, lung blood vessel deformity and tumour,etc.s vascular.
The sleep nearly to suspend syndrome has 20%- 27% to erupt PAH simultaneously to breathe to monitor the sleep, especially amalgamate the patient of the cardiovascular basic disease, should look for different reason to the patient, distinguish that treats, can just achieve still more greater result. The patient is besides medical history of snoring, it is very important to lead more sleep pictures and monitor, can offer the important information of PAH cause of disease.
The right heart conduit and lung artery radiography right heart conduit skill can determine the pressure directly, take the reactive test of blood vessel of acute lung. Right heart conduit and lung artery radiography diagnosis and differential diagnosis used for difficult case even, contribute to further reducing and misdiagnose and leak and examine.
Blood test include, resist nuclear antibody, resist the intersection of endothelial cell and antibody, resist the intersection of phosphatide and antibody and resist the intersection of RNP and antibody,etc., determine in serum antibody inside, can sift and check disease of connective tissue, there are inspections such as HIV serology, blood routine, liver renal function, thyroid gland function and urine routine,etc.. PAH patient when it is unidentified in reason about every one,especially in can't leak women patient for rheumatism indexes immune light year.
Diagnose that reduces to leak to examine in procedure type
PAH clinical symptom has no specificity, the cause of disease involves a plurality of disciplines, the clinician diagnoses consciousness is not high, especially easy to leak to examine and misdiagnose.
Do the diagnosis of PAH well, will need the clinician to improve understanding of PAH and diagnosis consciousness, possess multi-disciplinary knowledge or possess multi-disciplinary curing the division team. In addition inquire the medical history and carry on the detailed physical examination, check the essential sieve to the patient carefully, utilize routine inspection fully, can avoid detours, reduce, check expenses, reduce, leak, examine and misdiagnose.
As to a suspicious PAH patient, confirms whether there is PAH at first, can fix to pursue through electrocardiogram, X-ray flat scene and interesting supersound tentatively. Then is confirmed to be PAH of the type. Before specially diagnosing sending PAH, got rid of known PAH of different reasons at present in conformity with affirmation. Sometimes
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