循环章病案分析和循环章呼吸章复习思考题.doc

病案分析 A 60-year-old woman is admitted to the hospital plaining of extreme fatigue and weakness, shortness of breath (dyspnea), and swelling of her ankles. Her clothes no longer fit around the waist, and she has gained 3 kg in the past month. She finds that breathing is particularly difficult when lying down (orthopnea). Sleeping propped on several pillow no longer brings her relief. She has a history of chest pain and shortness of breath upon exertion. Her physical examination reveals cyanosis (blue skin tone), rapid respirations, rapid pulse, distended neck veins, ascites in the abdomen, edema in the ankles, and cold clammy skin. Her ventricular ejection fraction is . Her systolic pressure is 100 mm Hg, with a reduced pulse pressure. She is treated with digoxin and a diuretic and placed ona low-sodium diet. 一个 60岁的女子被送往医院后,极度疲劳和虚弱,气短,呼吸(呼吸困难) 的抱怨,她的脚踝肿胀。她的衣服不再适合在腰上,她已经增加了 3公斤,在过去一个月。她发现,平躺(端坐)时呼吸特别困难。睡觉时垫上几个枕头支撑也没有缓解。她有胸部疼痛和劳累后气短的历史。体检发现她紫绀(蓝肤色) ,呼吸急促,脉搏快,颈静脉扩张,腹部腹水, 脚踝水肿,皮肤湿冷。她的左心室射血分数为 。她的收缩压是 100 毫米***柱, 脉压降低。她以***和利尿剂以及低钠盐饮食治疗。 PS: ***:***是用于高血压、瓣膜性心脏病、先天性心脏病等急性和慢性心功能不全的一种药物。利尿剂: 主要是通过促进体内电解质( 钠离子为主) 和水分排出,使血容量减少,血压下降。该药降压作用较温和,作用持久。可能是什么病?为什么?治疗原则是什么? 心力衰竭心绞痛(胸痛) →冠状动脉堵塞→血液回流入心不足→心肌细胞氧气输送不足→心室收缩期不能产生足够压力射血心室收缩能力减弱→心室舒张末期容积固定的情况下收缩力和搏出量降低(搏出量降低可从射血分数和脉压降低看出) 收缩时射出占舒张末期容积部分比正常更少→心输出量减少→紫绀、易疲劳是组织血液供应不充足和血液含氧量不足的表现肺及外围组织水肿( 毛细血管滤过超过淋巴管容量时组织外液积累)( 因呼吸短促) 病例中毛细血管滤过增多(因静脉压