心源性哮喘

心源性哮喘是指由于各种原因引起的急性左心衰，临床以突发气急、端坐呼吸、阵发性咳嗽、咳粉红色泡沫痰等为临床表现的一组综合病征。别名：里德利综合征心病性哮喘Ridley综合征阵发性夜间呼吸困难综合征cardiacasthmasyndrome心病性气喘心源性哮喘综合征英文名：发病部位：心脏就诊科室：心血管内科症状：咳嗽伴哮鸣音粉红色或血性泡沫痰多发人群：老年治疗手段：药物康复疗法并发疾病：特指多种心律失常心衰是否遗传：否是否传染：否

症状1、突发气急、端坐呼吸、阵发性咳嗽、咳粉红色泡沫痰。坐位可略减轻。2、呼吸困难呼吸困难是左心衰竭最常见和最突出的症状，呼吸运动本来是一种不自觉的自主活动，但在呼吸困难时，患者感到憋气而需要用力和加快频率地呼吸，呼吸可达20～30次/min。3、端坐呼吸：是急性左心衰竭的特有体征，表现为平卧时呼吸急促，斜卧位时症状可明显缓解，严重时，患者被迫采取半坐位或坐位，故称端坐呼吸。4、夜间阵发性呼吸困难：是急性左心衰竭肺淤血或慢性肺淤血急性加剧的临床表现。5、急性肺水肿急性肺水肿是肺毛细血管压急剧而且持续增高的结果。

病因<pclass="placeholder">本病的主要病因一般有基础心脏病病史：<pclass="placeholder">①左心室心肌病变，如冠心病、急性心肌梗死、充血型心肌病、肥厚型心肌病、心肌炎等；<pclass="placeholder">②左心室压力负荷过重，如高血压、主动脉瓣狭窄、梗阻型心肌病等；<pclass="placeholder">③左心室容量负荷过度，如主动脉瓣关闭不全、二尖瓣关闭不全、某些有左至右分流的先天性心血管病(室间隔缺损、动脉导管未闭等)；<pclass="placeholder">④左心室舒张期顺应性减低，主要见于冠心病、高血压、梗阻型心肌病及伴有左心室肥厚的疾病；<pclass="placeholder">⑤严重心律失常，如心房颤动、心房扑动、阵发性心动过速、高度房室传导阻滞等；<pclass="placeholder">⑥心外疾病，如肺栓塞、脑血管意外、吸入刺激性气体、静脉补液过量、肾炎、肾衰竭等

检查本病的检查主要有心衰方面的检查：1、X线检查示两肺门阴影增加，不同程度的肺淤血如上叶肺静脉扩张、肺叶间水肿、KerleyB线或肺水肿(肺野呈云雾状阴影)。左心室扩大、左心房与肺动脉段增大等。心电图示左心室肥厚、ST-T改变。2、超声心动图示左心室内径增大，室壁运动振幅减弱等。3、动脉血气分析：可有明显氧饱和度降低，二氧化碳含量正常或下降，pH&gt;7.0。<!--[ifgtemso9]><xml><w:WordDocument><w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel><w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery><w:DisplayVerticalDrawingGridEvery>2</w:DisplayVerticalDrawingGridEvery><w:DocumentKind>DocumentNotSpecified</w:DocumentKind><w:DrawingGridVerticalSpacing>7.8磅</w:DrawingGridVerticalSpacing><w:PunctuationKerning></w:PunctuationKerning><w:View>Normal</w:View><w:Compatibility><w:DontGrowAutofit></w:DontGrowAutofit><w:BalanceSingleByteDoubleByteWidth></w:BalanceSingleByteDoubleByteWidth><w:DoNotExpandShiftReturn></w:DoNotExpandShiftReturn><w:UseFELayout></w:UseFELayout></w:Compatibility><w:Zoom>0</w:Zoom></w:WordDocument></xml><![endif]--><pclass="MsoNormal"style="padding:0pt0pt0pt0pt;mso-pagination:widow-orphan;text-align:justify;text-justify:inter-ideograph;"align="justify">4、心电图窦性心动过速或各种心律失常，心肌损害，左房，左室肥大等。<pclass="MsoNormal"style="padding:0pt0pt0pt0pt;mso-pagination:widow-orphan;text-align:justify;text-justify:inter-ideograph;"align="justify">5、肺超声：可见双肺大量B线。是最新发展的简便、快速、准确的诊断方法<pclass="MsoNormal"style="padding:0pt0pt0pt0pt;mso-pagination:widow-orphan;text-align:justify;text-justify:inter-ideograph;"align="justify">6、血清学监测：BNP明显升高<!--[ifgtemso9]><xml><w:LatentStylesDefLockedState="false"DefUnhideWhenUsed="true"DefSemiHidden="true"DefQFormat="false"DefPriority="99"LatentStyleCount="260"><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="Normal"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="NormalIndent"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footnotetext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="annotationtext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="header"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footer"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="indexheading"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="caption"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="tableoffigures"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="envelopeaddress"></w:LsdException><w:LsdExceptionLocked="false"Pri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诊断<pclass="placeholder">根据典型的症状与体征，结合BNP升高，肺超声示双肺大量B线，超声心动图是室壁运动减弱，一般不难做出诊断。本病应与哮喘相鉴别，后者多无心脏病病史，且多有反复发作哮喘病史。目前肺脏超声可以快速鉴别两者。

治疗<pclass="placeholder">1.一般措施(1)体位：立即让患者取坐位或半坐位，两腿下垂或放低，也可用止血带结扎四肢，每隔15min轮流放松一个肢体以减少静脉回流，减轻肺水肿。(2)吸氧：迅速有效地纠正低氧血症：立即供氧并消除泡沫，可将氧气先通过加入40%～70%浓度酒精湿化瓶后吸入，也可用1%硅酮溶液代替酒精，或吸入二甲硅油去泡气雾剂，降低肺泡内泡沫的表面张力使泡沫破裂，改善肺通气功能。一般情况下可用鼻导管供氧，严重缺氧者亦可采用面罩高浓度、大剂量吸氧(5L/min)，待缺氧纠正后改为常规供氧。(3)迅速建立静脉通道：保证静脉给药和采集电解质、肾功能等血标本。尽快送检血气标本。(4)镇静：吗啡3-5mg静注，必要时可以15分钟重复一次(5)利尿药：应立即选用快作用强利尿药，常用髓袢利尿药，如静注呋塞米(速尿)20～40mg或布美他尼(丁尿胺)1-2mg，以减少血容量和降低心脏前负荷。(6)氨茶碱：2尤适用于有明显哮鸣音者，可减轻支气管痉挛和加强利尿作用。(7)洋地黄制剂：常首选毛花苷C(西地兰)，近期无用药史者，0.4～0.6mg稀释后缓慢静脉注射。洋地黄对压力负荷过重的心源性肺水肿治疗效果好，如主动脉狭窄、高血压等。对伴有快速心房颤动的二尖瓣狭窄急性肺水肿更具救命效益。并快速型房颤或室上性心动过速所致左房衰应首选毛花苷C，也可酌用β受体阻滞药。2、血管活性药物（1）血管扩张药：常用制剂有硝酸甘油、硝普钠、酚妥拉明等。若应用血管扩张药过程中血压&lt;90/40mmHg(12/5.3kPa)，可加用多巴胺以维持血压，并酌减血管扩张药用量或滴速。（2）正性肌力药物β受体兴奋剂：多巴胺、多半酚丁胺磷酸二酯酶抑制剂：米力农（3）机械辅助治疗主动脉球囊反搏治疗（4）机械辅助呼吸机的应用用面罩法连续气道正压吸氧治疗，可用于各种原因严重急性左心衰，安全、有效。（5）治疗原发病、消除诱因如高血压者采用降压措施，快速异位心律失常要纠正心律失常;二尖瓣狭窄者施行紧急二尖瓣球囊成形术或二尖瓣分离术

预后<pclass="placeholder">心源性哮喘的近期预后与基础病因、心功能恶化程度及抢救是否及时,合理等因素有关。由于某些因素,如血压急剧升高,严重心律失常,输液过多及过快等原因造成的急性左心衰较易控制,预后相对较好。急性心肌梗死造成的急性心衰,心源性休克死亡率较高。心脏瓣膜病合并急性左心衰病死率高。62%二尖瓣?窄患者死于急性心衰。70%主动脉瓣狭窄患者死于急性左心衰。心肌疾病出现急性左心衰后大多逐渐发展为顽固心衰,预后甚差。

预防1.及时控制或祛除心内外的感染病灶，控制由溶血性链球菌所致的扁桃体炎等感染灶;预防和控制风湿活动;积极预防和控制感染性心内膜炎，呼吸道感染及其他部位的感染。2.迅速纠正心律失常：当心脏病患者发生心律失常时，应迅速给予纠正，异位心律恢复至正常窦性心律，或使过缓，过速的心室率控制在安全范围，以防止心衰的发生。3.纠正水电解质紊乱及酸碱平衡失调。4.治疗贫血并消除出血原因。5.避免输液过多，过快。6.停用或慎用某些抑制心肌收缩力的药物。7.其他：避免过度劳累，情绪激动，过度肥胖者应控制饮食。

本病的检查主要有心衰方面的检查：