动脉导管未闭（课件

动脉导管未闭 (patent ductus arteriosus PDA) 最常见先天性心脏病，占先心病 总数1520 女性多见，女 ：男:1 一、病理解剖类型 未闭的动脉导管位于连接 主动脉与左肺动脉起始处 1、管型 2、漏斗型 3、窗型 二、病理生理（血流动力学变化） 右心房 体循环血量减少 分流 右心室 肺动脉血流增多 主动脉 肺动脉扩张 左心室（扩大） 肺循环充血 左心房（扩大） 1、主肺动脉间的左向右分流，取决于 主、肺动脉间的压力阶差 动脉导管的直径和长度 体、肺循环间的阻力 2、左心室舒张期负荷增大 3、肺动脉压力和右心室负荷增大 二、临床表现 与分流量及肺动脉压力高低有关 导管中到大、分流量大：活动疲乏 、气促多汗、瘦弱苍白、声音嘶哑 ，反复肺炎心衰 典型病例 心脏体征：心前区隆起，心尖搏动强，有震颤 23连续性机器样杂音，心尖区 舒张期杂音，2亢进 血管体征：股动脉枪击音，毛细血管搏动征， 水冲脉 脉压差40mmHg 不典型病例 肺动脉阻力增高，仅听到收 缩期杂音，见于新生儿和严重肺 动脉高压患儿 四、辅助检查 1、线胸片：肺充血，肺动脉段突出， 主动脉结增宽，左房左室 大。严重病例双室大 2、心 电 图：小 PDA 正常。中等大小 PDA，电轴正常，左房左 室大，左室舒张期负荷增 加。大 PDA，双室大 3、超声心动图： 左房左室内径增宽，可显示 PDA 的形状和大小。多普勒检测 PDA分流血流的方向 4、心导管造影： 探查到动脉导管可确诊 肺动脉血氧右心室0.5Vol 右心室、肺动脉压力增高 主动脉造影显示PDA的形态和 长度 五、预后 与分流量大小及并发症有关。岁 后很少自然闭合 造成死亡的并发症：严重心力衰竭 ，严重肺动脉高压，感染性心内膜炎， 动脉瘤破裂 六、治疗 1、介入治疗 经导管堵塞动脉导管。有多 种堵塞装置。 直径0.3cm，选用弹簧圈 直径0.3cm，选用磨菇伞 2、外科手术，结扎动脉导管 根据病情，任何年龄都可手术 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