室间隔缺损护理查房_-_副本

分类（classification ）
根据缺损的解剖位置不同，通长分为膜部缺损、 漏斗部缺损和肌部缺损三大类。其中以膜部缺损 最常见。绝大多数是单个缺损，偶见多个缺损。 According to the different anatomical defects usually divided into membrane defect infundibular defect and muscular defect three categories The most common is membrane defect. The vast majority are single defect, many defects are rare.
• 3、严重肺动脉高压、有右向左逆向分流者， 禁忌手术。
patient who have a severe pulmonary hypertension, right to left shunt operation in reverse can not operate.
病因( Pathogeny)
心血管畸形的发生主要由遗传和环境因素以及相互作用所致
The congenital malformation relates to genetic factor, envir onmental factor or the interaction of both factors.
The area before the heart slightly elevated （2）胸骨左缘3-4肋间闻及3级以上粗糙响亮的
全收缩期杂音。
Left parasternal intercostal can heard 34 and more than 3 rough loud holosystolic murmur. （3）发育迟缓和不良
定义（definition ）
• 室间隔缺损是指室间隔在胎儿时期因发育 不全，在左右心室之间形成的异常通道。 室间隔缺损引起血液自左向右分流，导致 血流动力学异常。
The ventricular septum in the fetal period for dysplasia ,abnormal passage is formed in the left and right ventricular. Ventricular septal defect caused by blood from left to right shunt, resulting in abnormal hemodynamics.
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治疗(treatment )
• 2、缺损大、分流量大于50%或伴肺动脉高 压的婴幼儿，应早期在低温体外循环下行 心内直视修补术。
• Defect ofinfants and young children, divided flow is larger than 50% or with pulmonary hypertension who should be early in the downlink hypothermic cardiopulmonary bypass and open heart surgery.
• 1、缺损小、无血流动力学改变者，可暂观 察，部分病例可自行闭合。 patient who defect is small or hemodynamic is not changeing, can temporarily observation, some cases can close automatically.
Growth retardation and poor
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辅助检查
(laboratory examinations )
1、心电图(electrocardiogram )：
小型VSD正常范围，大 型VSD为左、右心室合 并肥大。重度肺动脉高 压时，显示双心室肥大、 右心室肥大或伴劳损。
2、X线检查(x-ray examination )
病理生理（Pathophysiology ）
• 室间隔缺损时，左心室血流向右分流，分流量取决 于两侧心室间的压力阶差、缺损大小和肺血管阻力 。肺动脉压力随右心负荷增大而逐渐增高。
• When the ventricular septal defects,the left ventricular flow shunt, flow depends on the pressure order difference between the two ventricles, defect size and pulmonary vascular resistance. The pulmonary arterial pressure gradually increases with right heart load .
中度以上缺损时，心影轻 到中度扩大，左心缘像左 下延长，肺动脉段突出， 重度梗阻性肺动脉高压时， 肺门血管影明显增粗， 甚 至肺血管影呈残根征
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3、超声心动图(echocardiogram )
示左心房、右心室内 径增大。多普勒超声 证实有左心室向右心 室的分流。
ห้องสมุดไป่ตู้
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治疗(treatment )
1.早期宫内感染(early intrauterine infection ) 2.孕母有放射线接触和服用药物(a radiation exposure and medications ) 3.孕妇代谢紊乱性疾病(metabolic disorder disease ) 4.妊娠早期酗酒、吸食毒品等
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临床表现（clinical manifestation ）
症状（symptom）
呼吸道感染 respiratory
乏力、多汗 Fatigue, sweating
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气促、心悸 Shortness 、palpitation
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• 2、体征(signs )： （1）心前区轻度隆起