肺高壓

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肺高壓
Pulmonary hypertensive arteriopathy (4348170715).jpg
肺高壓患者的血管的顯微切片,圖中可以見到血管內膜英语tunica intima中膜英语tunica media
分类和外部资源
醫學專科 胸腔醫學心臟病學
ICD-10 I27.0 , I27.2
ICD-9-CM 416.0, 416.8
DiseasesDB 10998
MedlinePlus 000112
eMedicine radio/583 med/1962 Secondary pulmonary hypertension Pediatric primary pulmonary hypertension Persistent newborn pulmonary hypertension
Patient UK英语Patient UK 肺高壓
MeSH D006976

肺高壓又稱肺動脈高壓(Pulmonary hypertension,簡稱PHPHTN),是描述肺循環內的壓力升高的情形。肺高壓會造成呼吸困難暈眩昏厥下肢水腫,肺高壓患者會因為心臟負荷增加令運動能力急速下降,以及發生其他症狀,可引致心臟衰竭導致病患死亡[1]。此症於1891年由恩斯特·馮·倫伯格德语Ernst von Romberg首次描述[2]。根據最新的分類,肺高壓共有六種形式[3]

症狀及徵象[编辑]

三尖瓣閉鎖不全

肺高壓的症狀包含:[4][5][6]

較罕見的症狀包含乾咳、運動時暈眩和嘔吐[5]。部分患者有咳血的現象,特別是肺高壓的某些亞型,如遺傳性肺動脈高壓、艾森門格症侯群,和慢性栓塞型肺動脈高壓等[7]。肺靜脈高壓的典型症狀為臥姿時呼吸困難(端坐呼吸英语orthopnea陣發性夜間呼吸困難英语paroxysmal nocturnal dyspnea),肺動脈高壓則無此現象[8]

其他典型症狀包含較強的第二心音。另外右心室肥大也會造成右心室產生第三心音,以及胸骨旁起伏英语parasternal heave。右心衰竭導致的全身性鬱血則可能合併有頸靜脈屈張、腹水,以及肝頸動脈回流英语hepatojugular reflux[5][6][9]

另有證據顯示肺動脈高壓也可能導致三尖瓣閉鎖不全英语tricuspid insufficiency以及肺動脈辦逆流英语pulmonic regurgitation[5][6][10]

病因[编辑]

1973年,世界卫生组织首次嘗試將肺高壓分類,當時分為原發性肺高壓,以及次發性肺高壓兩大類,並將初級肺高壓分為「叢狀動脈型」(arterial plexiform)、「靜脈阻塞型」(veno-occlusive),以及「血栓栓塞型」(thromboembolic)等[11]。1988年埃維昂萊班會議將次級肺高壓按原因分類[12]。隨著新研究的進展,2008年在达纳角召開的第四屆世界肺動脈高壓研討會更新了定義。以下為達納點的分類系統:[3]

組織細胞增生症肺淋巴管平滑肌增生症神經纖維瘤血管炎

治療[编辑]

肺高壓可利用藥物控制病情發展的程度,但不能根治,需要接受肺移植,如已引發較嚴重的心臟衰竭,就需要進行心肺移植,由於器官移植輪候需時,所以一旦確診,除藥物控制病情外,醫生都會安排病人排入器官移植的等候名單,以期病人在症狀惡化至嚴重心臟衰竭前,有適合器官進行移植手術[13]

參見[编辑]

參考文獻[编辑]

  1. ^ Pulmonary hypertension: MedlinePlus Medical Encyclopedia. www.nlm.nih.gov. [2015-12-30]. 
  2. ^ von Romberg, Ernst. Über Sklerose der Lungenarterie. Dtsch Arch Klin Med. 1891–1892, 48: 197–206 (德语). 
  3. ^ 3.0 3.1 Simonneau G, Robbins I, Beghetti M, 等. Updated Clinical classification of pulmonary hypertension. J. Am. Coll. Cardiol. 2009-06-30, 54 (1 Suppl S): S43–S54. PMID 19555858. doi:10.1016/j.jacc.2009.04.012. 
  4. ^ What Are the Signs and Symptoms of Pulmonary Hypertension? - NHLBI, NIH. www.nhlbi.nih.gov. [2015-12-30]. 
  5. ^ 5.0 5.1 5.2 5.3 Galie N, Humbert M, Vachiery JL, 等. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). European Heart Journal. 2016-01-01, 37 (1): 67–119. ISSN 1522-9645. PMID 26320113. doi:10.1093/eurheartj/ehv317. 
  6. ^ 6.0 6.1 6.2 McLaughlin VV, Archer SL, Badesch DB, 等. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. Journal of the American College of Cardiology. 2009-04-28, 53 (17): 1573–1619. ISSN 1558-3597. PMID 19389575. doi:10.1016/j.jacc.2009.01.004. 
  7. ^ Diller, Gerhard-Paul; Gatzoulis, Michael A. Pulmonary vascular disease in adults with congenital heart disease. Circulation. 2007-02-27, 115 (8): 1039–1050. ISSN 1524-4539. PMID 17325254. doi:10.1161/CIRCULATIONAHA.105.592386. 
  8. ^ Fang JC, DeMarco T, Givertz MM, 等. World Health Organization Pulmonary Hypertension group 2: pulmonary hypertension due to left heart disease in the adult--a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation. The Journal of Heart and Lung Transplantation: The Official Publication of the International Society for Heart Transplantation. 2012-09-01, 31 (9): 913–933. ISSN 1557-3117. PMID 22884380. doi:10.1016/j.healun.2012.06.002. 
  9. ^ Yusuf, Salim; Cairns, John; Camm, John; Fallen, Ernest L.; Gersh, Bernard J. Evidence-Based Cardiology. John Wiley & Sons. 2011-09-07: 70.3(figure). ISBN 9781444359459. 
  10. ^ Primary Pulmonary Hypertension Clinical Presentation: History, Physical Examination, Complications. emedicine.medscape.com. [2015-12-30]. 
  11. ^ Hatano S, Strasser R. Primary pulmonary hypertension. Geneva: World Health Organization. 1975. 
  12. ^ Rich S, Rubin LJ, Abenhail L, 等. Executive summary from the World Symposium on Primary Pulmonary Hypertension (Evian, France, September 6–10, 1998). Geneva: The World Health Organization. 1998. (原始内容存档于2002-04-08). 
  13. ^ 喘到心臟衰竭! 淺談肺動脈高壓. 全民健康基金會. 

延伸閱讀[编辑]

外部連結[编辑]