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Heart ModelsJSME International Journal,Series A46<1>, 200301刘锋,夏灵,张昕 Analysis of the Mechanical Response of Human Left Ventricle Subjected to the Active Force心电激励下的人体左心室力学响应分析计算力学学报19<4>, 20021101夏灵,刘锋 Simulation Study of the Influence of Electrical Asynchrony on Regional Mechanics ofthe Ischemic Ventricle using Electromechanical Heart ModelsThe Simulation Study of the Influence of Electrical Asynchrony on Regional Mechanics ofthe Ischemic Ventricle using Electromechanical Heart ModelsIEEE Computers in Cardiology29<>, 20020924夏灵,霍梅梅,刘锋 Study of the Potential Hazards of Cardiac StimulationSimulation Study of the Potential Hazards of Cardiac StimulationIEEE Computers in Cardiology29<>, 20020924夏灵,刘锋,赵华炜 Progress of Nerve Stimulation and Cardiac Stimulation Caused by Electromagnetic Field in MRIMRI中电磁场对神经及心脏刺激的研究进展生物物理学报18<>, 20020601夏灵,何超明 Construction of Composite Finite Element Mechanical Model of Human Left Ventrical人体左心室复合材料有限元机械模型的建立中国生物医学工程学报21<>, 20020601吴国华,刘锋,夏灵,吕维雪 construction 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你好,一般来讲,心率失调有非常多种,比如:心动过缓、心动过速等等,细的分类也是非常多。一般情况下,会有心悸,有些它会影响心脏的泵血功能,严重时会引起脑部及其它重要脏器的供血不足,如头晕,胸痛等等。 一般情况下,可以通过心电图检查,可以得知,心率失调是哪一种。 祝好。
心律失常的血流动力学改变的临床表现主要取决于心律失常的性质、类型、心功能及对血流动力学影响的程度,如轻度的窦性心动过缓、窦性心律不齐、偶发的房性期前收缩、一度房室传导阻滞等对血流动力学影响甚小,故无明显的临床表现。较严重的心律失常,如病窦综合征、快速心房颤动、阵发性室上性心动过速、持续性室性心动过速等,可引起心悸、胸闷、头晕、低血压、出汗,严重者可出现晕厥、阿-斯综合征,甚至猝死。由于心律失常的类型不同,临床表现各异。主要有以下几种表现: 1.冠状动脉供血不足的表现 各种心律失常均可引起冠状动脉血流量降低,偶发房性期前收缩可使冠状动脉血流量减低5%,偶发室性期前收缩降低12%,频发性的室性期前收缩可降低25%,房性心动过速时冠状动脉血流量降低35%,快速型房颤则可降低40%,室性心动过速时冠状动脉血流量减低60%,心室颤动时冠状动脉血流量可能为零。 冠状动脉正常的人,各种心律失常虽然可以引起冠状动脉血流降低,但较少引起心肌缺血,然而,对有冠心病的患者,各种心律失常都可以诱发或加重心肌缺血。主要表现为心绞痛、气短、周围血管衰竭、急性心力衰竭、急性心肌梗死等。 2.脑动脉供血不足的表现 不同的心律失常对脑血流量的影响也不同,频发性房性与室性期前收缩,脑血流量各自下降8%与12%。室上性心动过速下降14%~23%,当心室率极快时甚至达40%。室性心动过速时可达40%~75%。 脑血管正常者,上述血流动力学的障碍不致造成严重后果。倘若脑血管发生病变时,则足以导致脑供血不足,其表现为头晕、乏力、视物模糊、暂时性全盲,甚至于失语、瘫痪、抽搐、昏迷等一过性或永久性的脑损害。 3.肾动脉供血不足的表现 心律失常发生后,肾血流量也发生不同的减少。频发房性期前收缩可使肾血流量降低8%,而频发室性期前收缩使肾血流量减少10%;房性心动过速时肾血流量降低18%;快速型心房纤颤和心房扑动可降低20%;室性心动过速则可减低60%。临床表现有少尿、蛋白尿、氮质血症等。 4.肠系膜动脉供血不足的表现 快速心律失常时,血流量降低34%,系膜动脉痉挛,可产生胃肠道缺血的临床表现,如腹胀、腹痛、腹泻,甚至发生出血、溃疡或麻痹。 5.心功能不全的表现 主要为咳嗽、呼吸困难、倦怠、乏力等 心律失常可按发生原理,心律失常时心率的快慢,以及心律失常时循环障碍严重程度和预后分类。 (1)按发生原理,心律失常分为冲动发生异常、传导异常以及冲动发生与传导联合异常。这种分类方法主要根据实验研究结果,在临床诊断技术目前尚难确定心律失常电生理机制的状况下,实用价值不高。此外,某些快速心律失常起始和持续的机制可能不同,如由异常自律性引起的室性早搏,可由折返机制而形成持续型室性心动过速。 (2)按心律失常时心率的快慢,心律失常可分为快速性和缓慢性心律失常。近年来有些学者还提出按心律失常时循环障碍严重程度和预后,将心律失常分为致命性、潜在致命性和良性三类。这两种分类方法简易可行,结合临床实际,对心律失常的诊断和防治有一定帮助。 (二)体格检查 (1)听诊:心律失常的70%可通过听诊发现。如能有序地注意其频率与节律的变化,则能做出初步判断。例如过早搏动,可听到提前的心脏搏动和代偿性间歇。如阵发性室上速,可听到快速而规律的心脏搏动;而心房颤动则听到杂乱无章的心脏搏动,无论是强度、频率、节律,均无章可循。总之,心脏听诊既是内科医生的基本功,亦是临床发现心律失常的重要方法。 (2)颈静脉波动:一过性过度充盈的颈静脉犹如“搏动”样波动,是观察和诊断某些心律失常的重要方法。如完全性房室传导阻滞时,可见颈静脉的“搏动”,并可听到“炮击音”;心房颤动则可见强度不一、毫无规律的颈静脉充盈波。
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