每日一题_2025.08.14

A 79-year-old man with heart failure with reduced ejection fraction and atrial fibrillation presented to the emergency department with a 2-week history of shortness of breath. On physical examination, there was an irregular heart rhythm, crackles in both lungs, and pitting edema in both legs up to the mid-thigh. The jugular venous pressure was estimated to be 17 cm of water (normal value, < 4 cm of water). When firm, sustained pressure was applied to the center of the abdomen, there was a sustained increase in the jugular venous pressure of more than 3 cm of water for more than 10 seconds while pressure was applied. What is the mechanism of this physical exam finding?

一位79岁男性患者，患有射血分数降低的心力衰竭和心房颤动，因两周的呼吸困难病史到急诊科就诊。体格检查发现心律不齐，双肺有湿啰音，双下肢至大腿中部有凹陷性水肿。颈静脉压估计为17厘米水柱（正常值<4厘米水柱）。当对腹部中央施加持续、坚定的压力时，在施压期间颈静脉压持续升高超过3厘米水柱，并持续超过10秒。这一体格检查发现的机制是什么？

A. Decreased compliance of the pericardium心包顺应性降低

B. Impaired filling or contraction of the right ventricle右心室充盈或收缩功能受损

C. Left-to-right shunting左向右分流

D. Severe tricuspid regurgitation重度三尖瓣反流

E. Ventricular interdependence心室相互依赖

答案解析：

阳性腹颈静脉反流试验（如本例患者所进行的检查）表明，在压迫肠系膜静脉系统导致静脉回流增加时，右心室无法代偿这一血量负荷的增加。该体征可见于任何影响右心室充盈或收缩功能的疾病，包括双心室心力衰竭（本例即属此类情况）。

正确答案：B