主管护师学习日（20）：左心衰尽的临床表现
<img src="https://mmbiz.qpic.cn/mmbiz_jpg/6iaCPicKT14DZ8gKdc87gWhnxufDBaL8BoPUfV4mGQWy3qZ8ibczibI5HZghjd7E1wJmImT3fZqyXnexib3MmU9lBicw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&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;">为了让<span style="color: black;">大众</span>更好、更方便的记忆知识点，以后每周<span style="color: black;">咱们</span>将设置“学习日”，<span style="color: black;">每一个</span>学习日讲解一个小考点，并且设置原创试题和解析3道，<span style="color: black;">期盼</span><span style="color: black;">朋友</span>们踊跃参加练习哦！</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今日小考点</p><img src="https://mmbiz.qpic.cn/mmbiz_png/6iaCPicKT14DZ8gKdc87gWhnxufDBaL8BoTt1qFLVTVia13pXsGzPb1Dg5PiaIF6CC0kvjMv8RGTpj1WLickLF5icPmw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&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;"><strong style="color: blue;">左心<span style="color: black;">衰尽</span>的临床表现</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性心力<span style="color: black;">衰尽</span><span style="color: black;">指的是</span>在原有慢性心脏<span style="color: black;">疾患</span><span style="color: black;">基本</span>上<span style="color: black;">逐步</span><span style="color: black;">显现</span>心衰的症状和体征。其特征性的症状为<span style="color: black;">呼气</span>困难和体力活动受限，特征性的体征为水肿。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">01</strong></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;">重点</span>表现为肺循环淤血和心排血量降低</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">①不同程度的<span style="color: black;">呼气</span>困难</strong>：是左心<span style="color: black;">衰尽</span>最<span style="color: black;">重点</span>的症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">a．劳力性<span style="color: black;">呼气</span>困难：是左心<span style="color: black;">衰尽</span>最早<span style="color: black;">显现</span>的症状。运动使回心血量<span style="color: black;">增多</span>，左心房内压力增大，加重肺淤血。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">b．夜间阵发性<span style="color: black;">呼气</span>困难：是心源性<span style="color: black;">呼气</span>困难最典型的表现，<span style="color: black;">病人</span>入睡后<span style="color: black;">忽然</span>因憋气而惊醒，被迫坐起，重者可<span style="color: black;">显现</span>哮鸣音，<span style="color: black;">亦</span><span style="color: black;">叫作</span>为心源性哮喘。其<span style="color: black;">出现</span>机制为：<span style="color: black;">睡觉</span>平卧使回心血量<span style="color: black;">增多</span>，迷走神经兴奋剂<span style="color: black;">升高</span>使小支气管痉挛，膈肌抬高使肺活量减小等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">c．端坐<span style="color: black;">呼气</span>：肺淤血达到<span style="color: black;">必定</span>程度，<span style="color: black;">病人</span><span style="color: black;">不可</span>平卧，因平卧位会使回心血量<span style="color: black;">增加</span>，肺静脉压力<span style="color: black;">升高</span>，加重肺水肿，<span style="color: black;">亦</span>可使膈肌抬高，而<span style="color: black;">导致</span><span style="color: black;">呼气</span>困难。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">d．急性肺水肿：是左心<span style="color: black;">衰尽</span><span style="color: black;">呼气</span>困难最严重的<span style="color: black;">状况</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">②咳嗽、咳痰、咯血</strong>：是肺泡和支气管黏膜淤血、气道受刺激的表现。夜间加重，而站位、立位时减轻。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">a．咳白色浆液性<span style="color: black;">泡泡</span>样痰：<span style="color: black;">原由</span>是肺毛细血管压<span style="color: black;">升高</span>，浆液样分泌物渗出。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">b．痰带血丝：是<span style="color: black;">因为</span>肺微血管破损。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">c．咳粉红色<span style="color: black;">泡泡</span>样痰：是急性肺水肿的表现，<span style="color: black;">因为</span><span style="color: black;">血液</span>渗入肺泡<span style="color: black;">导致</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">d．大咯血：<span style="color: black;">长时间</span>慢性肺淤血可<span style="color: black;">引起</span>肺循环和支气管循环之间形成侧支，曲张破裂可致咯血。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">③其他症状</strong>：心排血量降低，<span style="color: black;">显现</span>倦怠、乏力、<span style="color: black;">头昏</span>、失眠、嗜睡、烦躁等症状。重者可有少尿及肾功能损害、肾前性肾<span style="color: black;">衰尽</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">④<span style="color: black;">通常</span>体征</strong>：心率加快，血压下降，脉压减小，<span style="color: black;">呼气</span>急促。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">⑤肺部湿啰音</strong>：是左心<span style="color: black;">衰尽</span>的<span style="color: black;">重点</span>体征，<span style="color: black;">因为</span>肺毛细血管压力<span style="color: black;">升高</span>，液体渗出到肺泡<span style="color: black;">导致</span>，随着肺淤血的加重，湿啰音可由局限于双肺底扩大到全肺，可伴哮鸣音。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">⑥心脏体征</strong>：左心室扩大，可闻及舒张<span style="color: black;">初期</span>奔马律，肺动脉瓣区第二心音亢进；心尖部可闻及收缩期杂音是左心室扩大<span style="color: black;">导致</span>相对性二尖瓣关闭不全<span style="color: black;">导致</span>。交替脉是左心<span style="color: black;">衰尽</span>的<span style="color: black;">要紧</span>体征，<span style="color: black;">平常</span>于高血压、冠心病<span style="color: black;">导致</span>的心衰。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">考点均为丁震医学教育原创</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">任何<span style="color: black;">公司</span>不得搬运</p>
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