右心室体积过载模仿肺栓塞:一个术内吸收液体诱导的心室相互依赖的案例
Chunliang Wang1, Yuzhu Fan2, Juan Wang1
1Department of Cardiology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China.
The American journal of case reports
|November 3, 2025
概括
外科手术引起的急性液体过载会导致右心室 (RV) 扩张和肺,模仿心声学上的肺栓塞 (PE). 要将其与PE区分开来,需要多模式成像和仔细的流体管理.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 医疗成像医学成像
背景情况:
- 心室相互依赖可以在急性右心室 (RV) 体积过载期间导致双心室功能障碍.
- RV扩张会损害左心室 (LV) 的服从性,导致肺压升高和心肺损害循环.
- 这些血液动力学变化可以模仿肺栓塞 (PE) 的心声回声学发现.
研究的目的:
- 报告一例心脏性肺,模仿PE,由于手术期间吸收液体.
- 突出在重症监护机构中区分液体过载与PE的重要性.
- 在内镜手术过程中强调血液动力学去补偿的预防策略.
主要方法:
- 一个75岁的妇女经历了尿路透镜式石,并有显著的液体吸收.
- 床边回声心脏学,以评估RV和LV功能,肺动脉压力和心肌流入.
- 肺CT血管造影 (CTPA) 排除血栓栓塞.
- 实验室检测包括动脉血液气体和NT-proBNP水平.
主要成果:
- 心声扫描显示了RV扩张,麦康奈尔的标志,D形LV,严重的三腹吐,肺动脉压力升高,并融合了米特拉E/A波,暗示PE.
- CTPA排除了PE,但证实了双边肺.
- 确立了液体吸收诱导的心脏性肺水腫的诊断.
- 用利尿和呼吸支治疗缓解了症状,使RV/LV比率和NT-proBNP正常化.
结论:
- 由于手术内液体吸收而引起的急性体积过载可以导致RV衰竭和肺,呈现出模仿PE的心声回声学迹象.
- RV扩张,隔膜平整和肺高血压可能是由非血栓栓塞的原因引起的,例如液体过载.
- 多模式成像 (心声和CTPA) 对于区分流体过载综合征和PE至关重要.
- 预防措施,如实时液体平衡监测,在内镜手术期间是必不可少的,以避免误诊和优化结果.
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