慢性肺心病的腹部体征

本文无选择的、随机的收集了1982年11月～1983年2月间,广州市、吉林市和通化市等11间医院571例患者,其中包括慢性肺心病320例,阻塞性肺气136例,其它心脏病115例,就腹部体征进行了互相间的对比观察。结果是慢性心病组288例(90.0％),阻塞性气肿组62例(45.5％)表现有剑突下搏动,而其它心脏病组只15例(13.0％)有此体征。此种搏动来源于垂悬的、搏动着的心脏(有时伴有右室肥厚),乃是心脏前下壁的搏动经膈肌传导而来,认为此征在慢性肺心病与其它性质心脏病之间可具诊断及鉴别诊断意义。同时发现慢性肺心病组241例(7.53％)阻塞性肺气肿组63例(46.3％)有明显腹壁紧张,其它心脏组18例(15.6％)有此征。这是由于长期的咳嗽、咳痰动作和腹式呼吸,致使腹肌运动过度所造成的。此征在慢性肺心病与其他性质心脏病间也有一定的诊断及鉴别诊断意义。至于肝脾肿大、腹水则无鉴别诊断意义。还指出在慢性肺心病并发严重支气管肺部感染的2例患者(0.62％),由于剧烈的毒血症和伴存的瀰漫性血管内凝血及低钾发生了麻痹性肠梗阻。表现明显腹部胀气、肠鸣音消失及便秘,连同患者本来就有的腹肌紧张体征,可能给人以“急腹症”的印象,对这类病例不要误作手术。

ABDOMINAL SIGNS OF CHRONIC PULMONARY HEART DISEASE

A Total of 571 cases observed from November 1982 to February 1983 has been analysed. These cases were taken at random from 11 hospitals in Jilin, Tonghua and Guangzhou. Of these, 320 were patients with chronic pulmonary heart disease, 136 obstructive emphysema, and 115 miscellaneous heart diseases. A comparative study in regard to the abdominal signs was carried out. In patients with chronic pulmonary heart disease, 288 (90.0%) showed subxiphoid pulsation in contrast to 15 (13.0%) in the group of miscellaneous heart diseases (P<0.01) .Subxiphoid pulsation is suggested as of the significance in the differential diagnosis as it is believed to be transferred from the antero=inferior wall of the right ventricle(always hypertrophic) via diaphragm to the abdominal wall. Tension of the abdominal wall was found in 241 (75.3%) in chronic pulmonary heart disease, in comparison to 18 (15.7%) only in miscellaneous heart diseases(P<0.01). Overexertion of abdominal wall by cough, expectoation and abdominal respiration are thought to be the causes of tension of the abdomiual muscles, which may be also of some significance in the differential diagnosis.