[医药卫生]肺拴塞

《[医药卫生]肺拴塞》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、pulmonaryarteryembolismDalianmedicaluniversityEmergencyDepartment一.definition:pulmonaryarteryembolism是内源性endogenous或外源性ectogenesis栓子堵塞肺动脉或其支引起肺循环障碍circulatorydisorder的临床和病理生理综合征，又称肺血栓栓塞病pulmonarythrombo-embolicdisease.临床上最常见的血栓来自下肢深静脉deepveinoflowerlimbs及盆腔静脉veinofcavitaspelvis。二.incidence

2、rate美国每年约70万以上人患有症状的肺栓塞pulmonaryarteryembolism我国肺栓塞诊断逐年增高，北京协和医院生前确诊率7.8%。basedisease1、eld2、heartdisease3、adipositas4、tumour5、pregnancyandparturition6、long-termbed7、drugs8、deepveinthrombosis三.PathogenyandPathophysiologyTypesofembolia:1.thrombusembolism2.fatembolism3.amnionicfluidembolism4

3、.airembolism5.tumorandbacterialembolusthelowerlimbsandcavitaspelvisdeepveinthrombosisabout68%ChronicheartandlungdiseaseandmalignantneoplasmAfterinterventionaltherapycongenitaldefectsofbloodclottingandfibrinolysispathology1、acutelargepulmonaryarteryembolism2、骑跨型血栓3、acutehypolargepulmonaryar

4、teryembolism4、moderatelyPulmonaryembolism5、micro-PulmonaryembolismPathophysiologythedistinguishoflunginfarctandpulmonaryarteryembolism肺梗死存在局部组织缺血、坏死1、changeofrespirationphysiology肺泡无效腔增大通气受限lossofalveolarsurfactantanoxemia2、thechangeofbloodstreambloodstreamlossofpulmonaryvascularbed，resist

5、anceofpulmonaryarteryincreaseandrightcardiacloadincrease.3、changeofneurohumorplateletactivatingfactorThromboxaneA2catecholamine5-hydroxytryptamineinducement:静脉内压发生急剧变化或静脉血流bloodstreamofvein量明显增加，均可造成血栓部分和完全脱落。Exertiondefecationexertionsuddenlymovementafterlong-termbedpredilectionsite:1、rig

6、htlung>leftlung、下肺>上肺2、bothsidelung>singleblungpathogenesisthemechanismofdeepveinthrombosis1、bloodstreamstagnant2、abnormalityofvesselwall3、bloodviscosityincreasepathogenesispulmonaryarteryembolism肺血管床血流急剧减少.肺A痉挛、肺血管阻力增加、肺A高压右心负荷增加、右心衰左心排血量下降、晕厥、血压下降、休克effectofhemodynamics:mechanicaln

7、essblockageofemboliareleaseofinflammationmediatorafterembolism临床表现(clinicrepresentation)symptom：absencespecificity临床上出现所谓“肺梗死三联征”dyspnoea、chestpainlessthan30％hemoptysissignshortnessofbreathisthemostoftensignvenothromboticsymptomandsign：下肢深静脉血栓主要表现为患肢肿胀、周径增粗、疼痛