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青紫型先心病中发病率更高的类型

2017-12-15 MedSci MedSci原创

该病是最常见的青紫型先天性心脏病,约占青紫型先天性心脏病的70%左右,约占所有先天性心脏病的10%。其主要病理改变有4种:主动脉根部增宽,右移骑跨、肺动脉狭窄、室间隔缺损(前连续中断)与右心室肥厚。前三项为原发病变,具有重要意义;而右心室肥厚则为继发性改变,为上述畸形所导致的后果。超声心动图检查本病有非常特异的表现,可作为本病的诊断依据。病史:患儿为1岁1个月婴儿,出生后即有口唇青紫,哭闹时明显,



该病是最常见的青紫型先天性心脏病,约占青紫型先天性心脏病的70%左右,约占所有先天性心脏病的10%。其主要病理改变有4种:主动脉根部增宽,右移骑跨、肺动脉狭窄、室间隔缺损(前连续中断)与右心室肥厚。前三项为原发病变,具有重要意义;而右心室肥厚则为继发性改变,为上述畸形所导致的后果。超声心动图检查本病有非常特异的表现,可作为本病的诊断依据。

病史

患儿1岁1个月婴儿,出生后即有口唇青紫,哭闹时明显,家长未重视,3天前患儿无明显诱因出现发热,最高体温38.9℃,无畏寒、寒颤、抽搐,予头孢美唑等抗感染治疗1天,体温不退,并且出现咳嗽,有痰不易咳出,为求系统诊治,来我科门诊就诊,门诊以青紫查因?急性支气管炎;收住我科,自起病以来,患儿精神、饮食欠佳,睡眠尚可,大、小便正常,体重无明显变化。

查体

一般情况,无明显脱水征,无明显三凹征,发育不良,营养较差,神志清楚。头颅未见明显异常,双眼瞳孔等大等圆,对光反射存在,粗测耳听力未见异常,无鼻翼煽动,鼻无阻塞口腔粘膜红润口唇发绀,咽稍充血,未见溃疡,双侧扁桃体不大,舌居中,未见异常,无声音嘶哑。 颈软,无颈动脉异常搏动,肝颈静脉回流征阴性。气管居中,甲状腺未见异常。胸廓未见异常,无压痛,胸式呼吸未见异常,胸壁静脉未见异常,乳房未见异常。腹软,全腹无压痛,肝脾触诊不满意,双侧上中输尿管点压痛未查。心率124次/分,节律齐,胸骨左缘第2-4肋间可闻及Ⅲ级粗糙喷射性收缩期杂音,未闻及心包摩擦音。双肺呼吸音明显增粗,未闻及明显干湿啰音、哮鸣音,无胸膜摩擦音。

辅助检查:

胸部X线检查心影可见心尖圆钝上翘,肺动脉段凹陷,上纵隔较宽,肺门血管影缩小,两侧肺纹理减少,透亮度增加

心电图电轴右偏,右心室肥大

超声心动图主动脉内径增宽,骑跨于室间隔之上,室间隔中断右室流出道及肺动脉狭窄右心室、右心房内径增大,左心室内径缩小

血常规白细胞 10.05 10^9/L中性粒细胞百分比12.9 %淋巴细胞百分比 75.0% 血红蛋白97g/L

其他:降钙素原1.86 ng/ml肺炎支原体抗体阳性药敏试验多重耐药菌株

简要解析:

典型病例的诊断不难。生后数月出现青紫,伴阵发性呼吸困难和缺氧发作,活动后喜蹲踞,极少有心力衰竭。在胸骨左缘第3、4肋间闻及喷射性收缩期杂音伴P2减弱。通过上述病史、查体及辅检已可以初步诊断本病,若要进一步确诊则需行心导管检查和心血管造影。你们对这个疾病了解了吗?

完整病例请前往【梅斯医生】→病例库→心血管→“口唇青紫1年余,发热3天,咳嗽2天 

更多点评分析,趣味的学习,详情尽在梅斯医生上,您可以在这里体验模拟诊疗


下载链接:http://www.bioon.com/index_forword.asp?id=9429

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    2018-04-30 1771ae4158m

    学习一下很不错

    0

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    2017-12-24 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2017-12-17 ssnine
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    2017-12-16 人间可客

    学习了.谢谢分享!

    0

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    2017-12-16 1209e435m98(暂无昵称)

    学习了.谢谢分享!

    0

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