Old age source _'s general knowledge of heart disease of the chronic lung

Old age source _'s general knowledge of heart disease of the chronic lung

Chronic lung worry is a kind of more common heart disease of old age, accounts for more than 5% - 10% in heart disease, it is the highest in the Northeast, account for 15% - 35%. This disease exists throughout the year, and acute because of airway infection in spring of winter festival more to break out, the case fatality rate is relatively high, about 30%.
[Cause of disease ]
Chronic lung worry is chronic bronchitis, pulmonary emphysema and other lung, chest disease or heart disease that vascular pathological change of the lung caused. Artery high pressure of lung, increasing or right heart function of right ventricle are not complete.
[Diagnostic standard ]
The source diagnostic standard of the heart disease of chronic lung that the national lung worry meeting was made was in 1977:
1. Chronic lung, chest disease or vascular pathological change of the lung: Medical history of the main foundation, electrocardiogram, X-ray, consulting the lung function,etc. are made.
2. The right heart function is not complete, are mainly shown as neck intravenous anger one, hepatomegaly tenderness, liver neck vein return to, flow masculine gender, lower extremities edema and venous pressure and increase.
3. The diagnosis basis that the artery high pressure of lung, right ventricle increase:
(1)Physical sign: Ensiform process lay, appear systolic phase beat, the intersection of lung and the intersection of artery and petals of the intersection of district and second hyperfunction sound, heart sound, district of tricuspid valve, the intersection of apex of the heart and district strengthen or appear the intersection of systolic phase and noise obviously relatively.
(2)X-ray diagnostic standard:
The artery bes and expands and is greater than or equal to 15mm under the right lung;
Lung artery section intermediate to stress or his height is greater than or equal to 3mm;
The right ventricle is loose (the oblique location before the left) .
One in the above-mentioned three items can be diagnosed.
(3)Electrocardiogram diagnostic standard:
Essential condition:
The average electric axle is greater than or equal to 90 degrees volume;
V1R/ S greater than or equal to 1;
Severe along clock to turn the location (V6R/ S less than or equal to 1) ;
RVl+ SV5gt; 1. 05m ;
AVR: R/ S or R/ Q is greater than or equal to 1;
V1-V3Myocardial infarction) except take the form of QS, Qr ' take ;
Lung type P wave: P wave voltage greater than or equal to 0. 22m ,The voltage is greater than or equal to 0. 2m The spike presenting type, P voltage gt at the time of the low-voltage; I/ 2R, the spike presenting type.
Secondary condition:
Limbs lead and unite the low-voltage;
Complete or the bunch of right of incompleteness is propped up and blocked.
Can diagnose, that possessed two secondary conditions is the electric chart of heart of the suspicious lung worry now while possessing an essential condition.
[Treat ]
1. Relieve the prevention and cure of one
To the lung worry patient who is already formed, relieve a treatment and build up health emphatically, prevent cold and improve the heart and lungs function, divide stating leaving:
(1)Build up health: Encourage patients to participate in the physical training in power, such as taking a walk, taijiquan,etc., patient that tempered through certain time, movement endurance can greatly increase, should insist on. Take the intersection of traditional Chinese medicine and dangshen, rhizome of large-headed atractylodes, enrich the intersection of bone and lipoprotein, Fructus Schisandrae Chinensis, frost harvest the intersection of eggplant and whom seedling,etc. make it supports to be exactly firm pill this, there are good results on improving the resistance of whole body, preventing the worry progress of lung.
(2)Prevent cold: Use the cold water washing face at ordinary times, summer rub one's body with a towel with the cold water, can strengthen cold-resistant ability, core sour the intersection of casein and the intersection of parenteral solution and skin lay intramuscular injection twice, No. 2 Branch each time, to prevent chronic bronchitis and reduce cold efficient to reach 85% every week; The forearm scratch law of Bacillus Calmette-Guerin dies, it is 88 to prevent cold efficiently. 78% ; In the prevailing season of cold, there are certain results on preventing cold to steam and sterilize the room smokedly by eating the vinegar.
(3)Breathe and do exercises: Breathe, contract with the intersection of diaphragm and skin moving, coming, finishing up and down by the intersection of thoracic cage and piece mainly, normal the intersection of people and the intersection of moisture and quantity 25% lean the thoracic activity against, 75% depend on the skin of diaphragm and move about. Patient's functional residual capacity of pulmonary emphysema increases, the thoracic activity is reduced notably, a lot of patients get used to the chest employing type to breathe, so the moisture amount is lower, further weaken the keeping in touch with amount of alveolus. Should instruct the patient how to turn into the chest type and breathe and breathe for the diaphragm type patiently, the breath which become rapid and narrow and shallow, in order to greatly breathe slowly and deeply leisurely, raise moisture quantity, promote the keeping in touch with amount of alveolus, reduce and breathe resistance and breathe the work, in order to achieve the goal of improving and taking a breath. The diaphragm type of walking is breathed and done exercises, go on twice every day, after grasping the diaphragm type to breathe, correct the chest type to breathe naturally.
2. Acute treatment that breaks out for period
Lung worry acute to break out one, the condition is critical, the case fatality rate is relatively high, it is one of the critical diseases the old age. The clinical manifestation that it causes has two groups: One behave respiratory tract, cough, unusually,etc. expectoration, out of breath cyanosis, dyspnea, the intersection of respiration and subside, the intersection of lung and do, wet the intersection of Yue and sound, the intersection of vim and vigour and analysis; Another group, in order that edema, liver are big, the neck is intravenous the right heart is depleted to behave that anger one, masculine gender of intravenous reflux of liver neck, venous pressure are raised,etc..
Its therapeutic method is as follows:
(1)Control the airway infection actively: Lung the intersection of worry and most common inducement that heart decline breathe out but airway infection, lung of worry and aggravate, hide very much more, generate heat and leucocyte increase actually rare, pay attention to, appear the depression, appetite fail, weak, it is easy to diagnose that the properties of especially breathing hard and aggravating and phlegm change. When there is airway infectioning, make phlegm fungus to train firstAnd medicine is tested quickly, select the most appropriate and most effective antibiotic for use to treat according to the result.
(2)The oxygen intake of long Cheng's low flow: Give long Cheng for 15-20 hour every day with the nose conduit law, flow is the oxygen intake of 1- 1.5L/ min low flow. Can reduce the lung arterial pressure, improve symptom, improve life quality and lengthen the time of surviving. And short distance oxygen intake, can improve symptom, but not influenced lung arterial pressure and prognosis.
(3)Expand the bronchus: Give aminophylline 0. 25g dissolves into 100mL10% glucose liquid slowly quietly and drips, 2-3 times a day, maximum dose does not exceed 1. 0g. Not merely can expand the bronchus and improve the breathing function, and improve heart function and diuresis function. And can be worthy of using 2Receptor excitant breathe heavily while being easy the intersection of fairy and 2- 8mg take orally 3 times a day, or atomization suck people, add, use glucocorticoid and eliminate the phlegm pharmaceutical if necessary.
(4)Improving and keeping in touch with: General therapeutic method invalid and when the intersection of patient and dyspnea, cyanosis aggravate, can use breath excitant: But Lamine, can be light according to the condition to pay most attention to 3- 10 (0 for each one. 375g) It is a bit quieter to add people 10% G S500ml; 2-5 Lip river Beilin, (each 3mg) Add people 10% G S500ml quietly to drip, it is better that the above-mentioned two kinds of medicines replace the result of use. It can cause tachycardia and a burst of contraction convulsions to notice the dosage passing.
(5)Use foreign digitalis correctly: According to seeing the lung heart patient with change of dynamics of blood after foreign digitalis, after using foreign digitalis, have not seen that obviously there is reducing at various degrees at pressure in latter stage of relaxation of the right ventricle. It means that it is even more important to improve and keep in touch with the function and correct oxygen deficiency than foreign digitalis preparation. So, divide the condition of lung worry into two kind obvious lung and infect and breathe depletedly. The former should not use foreign digitalis conventionally, but the latter can use, but the dosage should be small, declined dosage with the general heart 1/ 3- 1/ 2, And should select function for use fast, duration is short, preparation with low toxicity, such as blue in the west, the digoxin is proper. In addition, when should also especially emphasize lung worry, even foreign digitalis amount has been already enough, but like there is hypoxemia disease, high carbonic acid blood disease, is infected with etc. not to correct and control, the heart rate still fast, these is not no that foreign digitalis quantity is insufficient, as to this, should strengthen and resist infection, improve and keep in touch with the function actively.
(6)Use diuretic rationally: Lung heart patient should careful to use strong diuretic, speed sour in urine, diuresis for instance, because it can arrange, appear much moisture and potassium, sodium arrange the phlegm in a short time, make the respiratory tract unobstructed.
d. Supplement alkali pharmaceuticals appropriately, such as hydrogen sodium carbonic acid, this is only a kind of emergency measure, do not solve the keeping in touch with amount of alveolus, mending alkali simply can't solve the problem.
Breathe out the acid and amalgamate and take the place of alkali: Lung worry and breathing acidosis mainly cure the source like erupting metabolic alkalosis simultaneously at the same time, and mortality is very high, prognostic difference. For two reasons, first, it is too fast to keep in touch with, discharge CO of retention rapidly in it2,Its speed far exceeds the speed that the kidney discharges carbonic acid hydrogen salt, and cause temporary metabolic alkalosis; Second, employ strong diuretic, hormone, fail to mend potassium, mend chlorine or be disgusting, vomit and cause low potassium, low chlorine alkalosis in time again. Vim and vigour characteristic BE and BB raise and pH greater than 7 at this moment. 45.
It handles the principle:
a. Mend chlorine 3- 6 grams of potassium day when there are low potassium, low chlorine, should also mend magnesium.
b. The serious one of alkalosis (PHgt; 7. 5),Intravenous to instil arginine 20g hydrochloride, can also give nitrogen amide 0 of vinegar. 25 grams, 2 times a day, short-term application.
c. In the rescue of high carbonic acid blood disease, must avoid excessively keeping in touch with, do not need excessive diuresis either, and pay attention to supplementing the electrolyte.
(9)Prevent and cure low and ooze blood disease: Reason that disease take place employ for diuretic too much and food take a photograph of people to be enough to wait for. It is reported the lung heart patient permeates, presses, checks, finds blood plasma, there is 43. 75% ooze blood disease for being low. The intersection of blood and sodium lower than 130mmol/ L to be most many, have about equal the intersection of patient and chlorine lower than 90mmol/ L and potassium and lower than 4mmol/ L also in the disease.
Lung worry erupts the low clinical manifestation of oozing blood disease simultaneously:
Light disease person show as gastrointestinal symptom, vomit while being sick, the appetite obviously fails, the muscular strength is reduced notably, the tendon is reflected obtusely.
The serious one can cause the brain cell edema, is called low oozing encephalopathy, is shown as consciousness is fuzzy, the expression is indifferent, has a liking for and sleeps, goes into a coma etc.. Should distinguish with lung encephalopathy at this moment, but can coexist both, should notice.
It prevents and cures the method:
a. Avoid abusing a large amount of diuretic.
b. Present low to ooze blood, employ 3- 4 days such as liquid such as crystal behind the disease, the blood plasma can basically resume or be close to pigeonhole normally while permeating.
3.Prevent and cure lung encephalopathy: About 20% incidence its, nearly 50% mortality lung worry acute to break out a most serious complication. It is because of lung, heart function depleted serious oxygen deficiency and carbon dioxide retention that caused, make the brain blood vessel expand, the blood flow volume of brain increases, cause the brain to organize congestion edema, press and rise in the cranium, and cause the nerve, spiritual symptom, namely call lung encephalopathy.
(1)Diagnose:
Chronic lung, chest disease or vascular disease of the lung accompany the lung, heart function to be depleted, the clinical manifestation which is short of oxygen and carbon dioxide retention appears.
It have consciousness obstacle, it is spiritual nerve symptom and physical sign,and can except persons who causes reason other.
Can assist to diagnose to make the analysis of vim and vigour while having ready conditions. PH drops, PaCO2Raise, PaO2Decline.
(2)Grade clinically:
Light lung encephalopathy:
a. The above-mentioned PaCO245mmHg, appears the look in a trance, indifferent and thinking symptom of sleeping on, unusual or excited multi-lingual of spirit,etc..
b. There is not unusual physical sign of nervous system.
Medium-sized lung encephalopathy:
a. PaC02Above 55mmHg, symptom of twitching or speaking incoherently slightly etc. that present simple going into a coma, delirium, restless, muscle.
b. Complications such as the supreme digestive tract bleeding or DIC,etc..
Heavy-duty lung encephalopathy
a. PaCO2Above 65mmHg, symptom of going into a coma or the epilepsy kind appears to twitch etc..
b. The conjunctiva of eyes congests, edema, many sweats or looking at the papilla edema, stimulate various reactionlessly, physiological areflexia, reflect pathology, myosis or breaking up greatly.
c. Can amalgamate upper digestive tract bleeding, DIC or shock.
(3)Deal with:
It is depleted to breathe correction: Breathe the depleted main reason that is lung encephalopathy. So, must take the correction of comprehensive effective measure to breathe depletedly.
For example:
a. Employ strong antibiotic to resist infection.
b. Employ and breathe excitant, the trachea intubate or tracheostomy if necessary, the machinery of walking is breathed in order to improve and keep in touch with the function effectively.
C. Employ the adrenocortical hormone, it is flat for aminophylline, nitre benzene to relieve bronchus and lung artery convulsion.
d. The low flow long Cheng gives oxygen and eliminates the phlegm to arrange the phlegm in order to correct oxygen deficiency and high carbonic acid blood disease etc..
Reduce the inner high pressure of cranium: The lung encephalopathy patient has brains edema at various degrees, brain hernia can take place in the serious one, so need to lighten the brain edema with dehydration pharmaceutical, reduce and press in the cranium. But should notice, it can cause the blood to concentrate, electrolytic disorder, acid-base balance to lack proper care that dehydration pharmaceutical is used, the phlegm liquid is dry and hard,etc., should nurse one's health appropriately; If give low molecular dextrose anhydride 250ml 1- 2 times a day at the same time, can prevent the blood from concentrating, avoid bringing out DIC; Suck people and reduce phlegm for atomization, help the phlegm to discharge, keep the respiratory tract unobstructed, should correct electrolyte and acid-base balance disorder in right time at the same time.
Promote the cellular metabolism of brain:
a. Cytochrome C15mg, coenzymatic unit A50, ATP20mg, thiamine650mg adds 10% of the glucose liquid 500ml of people quietly to drip, 1 times a day.
b. One gram of brains fan: Promote and organize the supersession to resume, improve the function of brain cell, dissolve in 10% of the glucose 500ml quietly and drip by 1 gram, 1 times a day.
c. Chlorine ester is awake: It is the centre excitant, can regulate the neural cellular metabolism and have excited function, with 250mg skin note or quiet note, 2-4 times a day.
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