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是一种血流动力学和病理生理学状态,可发生于多种疾病。根据病理生理机制、临床表现和治疗反应类,PH诊断步骤可概括为疑诊、确诊、求因分类及严重程度评估。超声心动图是重要的无创筛查手段,但因过于敏感而存在一定的假阳性。右心导管检查是确诊PH、评估血流动力学损害程度、进行急性血管扩张试验的标准方法。根据PH诊断流程进行准确的临床分类和功能分级对指导治疗、判断预后具有重要意义。 相似文献
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近年来证实几种血管扩张药对急性血液动力学效应有利,并提出急性心肌梗塞合并严重泵衰竭病人使用血管扩张药对预后有良好影响。本文就急性心肌梗塞老年病人用血管扩张药者和未用血管扩张药者在早期和晚期预后以及血液动力学方面影响作一对比 相似文献
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肝-肺综合征(HPS)是慢性肝病和与之相关的肺血管扩张的疾病,主要特点有:慢性肝病,缺氧和肺内血管扩张三联征。本文介绍了HPS的病因、机理、诊断、治疗和预后。 相似文献
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过去几年中,对有明显或代偿性心力衰竭患者应用血管扩张剂曾作了广泛的研究.这种治疗有理论上的限制,而且许多严重慢性病变患者在血管扩张剂治疗后仍有难以忍受的症状.另一种治疗方法是应用兼有血管扩张与正性肌力作用的药物.小剂量多巴胺和多巴酚丁胺能增强心肌收缩力,并通过直接或反射性的机制使心血管系统产生一定程度的血管扩张,然而这些药物仅供静脉注射. 相似文献
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每年全球有数百万患者因急性心力衰竭发作入院,如何改善急性心力衰竭患者的临床预后是一项巨大的挑战。在急性心力衰竭患者中,血管扩张剂是继利尿剂之后第二常用的药物。当前仍缺乏足够证据证明传统药物治疗在改善急性心力衰竭患者的临床预后上有明显获益。近些年,在药物治疗急性心力衰竭的研究中研发了一些新型血管扩张剂,包括可溶性鸟苷酸环化酶调节剂、新型硝酰基前体药物、利钠肽、松弛素及血管紧张素受体偏配体,旨在改善急性心力衰竭患者住院期间及出院后的临床结局。 相似文献
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陈洁 《中国心血管病研究杂志》2021,19(9)
肺动脉高压(pulmonary arterial hypertension,PAH)是各种原因所致的一种慢性肺血管性疾病,主要表现为肺动脉重构和肺血管阻力进行性增加,最后导致右心室功能衰竭和死亡,预后极差。PAH时交感神经表现为过度激活,交感激活后可以通过多种机制参与肺动脉重构及加重右心室功能紊乱。干预交感神经可以改善PAH的预后,其原因与改善PAH的右心室功能和肺动脉重构密切相关,但是不良反应也较多,交感神经系统参与PAH发生发展的确切机制尚不完全知道,仍需进一步研究。 相似文献
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肺动脉高压(PAH)是由已知或未知原因引起肺动脉内压力异常增高的病理生理综合征,存在肺循环障碍与右心高负荷,可导致右心功能衰竭甚至死亡[1,2]。PAH的病因复杂,临床症状和体征缺乏特异性,远期预后极差。有研究表明,PAH在确诊后中位生存时间仅为2.8年[3]。其中右心室功能(RVF)在心力衰竭和肺动脉高压(PAH)中具有重要的预后意义[4]。因此了解PAH发展过程中肺循环及右心室的变化,及它们之间的耦合关系,对临床治疗和预后有重要指导价值。 相似文献
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肺动脉高压(PAH)是一种进展快、预后欠佳、死亡率高的心血管疾病。研究表明,肺血管重构是PAH发生发展的重要病理基础,而肺动脉平滑肌细胞的增殖和肥大是PAH肺血管重构的主要病理改变。在PAH时,肺血管平滑肌细胞由收缩表型向增殖状态的合成表型转化,主要表现为肺血管平滑肌细胞的增殖和肥大。上述病理改变最终导致肺血管管腔狭窄,管壁僵硬,进而促进PAH的发生发展。本文对肺动脉平滑肌细胞在PAH中的关键作用及作用机制进行阐述,为临床防治PAH提供新靶点和新策略。 相似文献
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Significant advances in the treatment of pulmonary arterial hypertension (PAH) have occurred over the last 10 years, starting with the approval of epoprostenol in 1998. Subsequently, multiple additional medications have received approval, including a subcutaneous prostacyclin, an inhaled prostacyclin, and oral medications in 2 separate classes. Over this same period, the classification of pulmonary hypertension has been revised with changes including the substitution of the term idiopathic for primary PAH and an expanded list of conditions felt to be associated with the development of PAH. Long-term follow-up studies have provided better information on prognosis and expected outcomes with treatment, with particularly valuable data on reassessment of prognosis after treatment with epoprostenol. Combination therapy is more frequently being used, and limited data on novel therapies such as stem cell transplantation have been published. The purpose of this review is to describe the current state of evidence for the diagnosis, prognosis, and treatment of the patient with PAH. 相似文献
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肺动脉高压是各种原因引起的肺动脉压力持续升高的临床综合征.若缺乏相应的治疗,将导致肺血管重塑,最终发展为右心衰竭,预后极差.但早期诊断及合理治疗可提高该病患者的生存率并改善患者的生存质量.近年,对肺动脉高压发病机制认识的不断深入推动了肺动脉高压治疗手段的发展,现将肺动脉高压治疗的最新进展综述如下. 相似文献
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Pulmonary arterial hypertension in congenital heart disease 总被引:4,自引:0,他引:4
Pulmonary arterial hypertension (PAH) is a recognized complication of congenital systemic to pulmonary arterial cardiac shunts. The prognosis of PAH in this situation is better than primary or other secondary forms of PAH. Our knowledge of the pathophysiology of PAH complicating congenital heart disease has evolved over the past decade. Despite differences in etiology and pathobiology, therapies that have proven successful for primary PAH may benefit this group of patients. 相似文献
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H. Olschewski 《Der Pneumologe》2013,10(1):53-57
Pulmonary hypertension has dramatically evolved as a new scientific field triggered by the development of targeted pulmonary arterial hypertension (PAH) therapies. Pulmonary hypertension is defined by elevated resting pulmonary arterial pressures but the definition of normal values during exercise is currently not possible. Diagnostic tools include the history, physical examination, electrocardiography (ECG), thoracic X-ray and echocardiography. In scleroderma patients a reduced diffusing capacity of the lungs for carbon monoxide (DLCO) is a marker of PAH. Approved PAH therapies include three prostanoids, two endothelin receptor antagonists and two phosphodiesterase 5 inhibitors. These therapies have substantially improved the prognosis of PAH patients. A novel soluble guanylate cyclase (sGC) stimulator has been submitted for approval. There are increasing numbers of elderly PAH patients who have an adverse prognosis as compared with classical PAH patients. In particular those with simple or combined heart and lung diseases pose a challenge for the future. 相似文献
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Chakinala MM 《Seminars in respiratory and critical care medicine》2005,26(4):409-416
Pulmonary arterial hypertension (PAH) is a progressive arteriopathy of the pulmonary circulation that can affect a wide group of patients. Presentation and natural history of PAH are intimately linked to progressive right ventricular failure. Historically, survival in PAH has been poor, especially for patients with PAH associated with progressive systemic sclerosis and human immunodeficiency virus. Oral, subcutaneous, and intravenous therapies that have emerged during the last decade can improve symptoms and hemodynamics. This review explores the impact of these therapies on prognosis in PAH, which ultimately rests on the ability to reverse the pulmonary arteriopathy and preserve right ventricular function. 相似文献
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