肺血栓栓塞症的诊断和治疗

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1、肺血栓栓塞症的诊断和治疗肺血栓栓塞症相关名词及定义肺血栓栓塞症诊断与治疗指南（草案）中的有关名词肺血栓栓塞症(pulmonarythromboembolism,PTE)肺栓塞(pulmonaryembolism,PE)肺梗死(pulmonaryinfarction,PI)深静脉血栓形成(deepvenousthrombosis,DVT)静脉血栓栓塞症(venousthromboembolism,VTE)VTE=DVT+PTE其他相关名词遗传性易栓症、慢性血栓栓塞性肺动脉高压、经济仓综合征、肺动脉原位血栓形成、特发性肺动脉高压、家族性肺动脉高压

2、、出血性肺不张其他类型肺栓塞气体栓塞、脂肪栓塞、羊水栓塞、粟粒性肺栓塞（肿瘤、虫卵）、其他（菌栓、药栓）脂肪栓塞(fatembolismsyndrome,FES)定义：长管状骨骨折等严重创伤后脂肪滴阻塞肺循环或脑循环等其他微血管而引起的临床症候群。主要临床表现为呼吸衰竭、脑功能障碍及淤斑。病理生理：肺血管的机械性梗阻和肺间质的“生物化学性”炎症反应。Fatembolismina58-year-oldwomanwhopresentedwithsuddendyspnea.Thepatienthadundergoneintramuscularinj

3、ectionofsomefattymaterialsintothebuttockseveraldaysearlier.(a)Radiographshowsbilateralground-glassareasofincreasedopacity.(b)Thin-section(1-mmcollimation)CTscanobtainedattheleveloftheaorticarchshowswidespreadpatchyground-glassattenuationandconsolidation.羊水栓塞(amnioticfluidem

4、bolism,AFE)原因：妊娠期羊水中胎儿产物进入母体循环而引起。途径：分娩时羊水经宫颈内膜血管静脉撕裂部位;胎盘早剥和剖宫产时损及胎盘附着部位的静脉窦;子宫损伤或子宫撕列部位。病理生理：肺血管栓塞;变态反应;凝血机制障碍。(a)Radiographshowsbilateralwidespreadairspaceconsolidation.Endotrachealintubationwasperformed.AFEina40-year-oldwoman.Thepatientexperiencedsuddenrespiratorydistre

5、ssshortlyaftergivingbirthbycaesareansection.(b)Onafollow-upradiographobtained3dayslater,theextentoftheparenchymalareasofincreasedopacityhasdecreased.Achesttubewasinsertedintotherightpleuralspacetorelievetherightpleuraleffusion.DVT-PTE的流行病学发病率和患病率西方国家：DVT和PTE的年发病率分别为1.0‰和0.5

6、‰美国：PTE年新发病例数650，000-700，000中国：阜外心血管病医院900例连续尸检：11.0﹪（段以上PTE）易患因素年龄与性别、血栓性静脉炎、静脉曲张、心肺脑血管疾病、创伤、肿瘤、制动、妊娠和口服避孕药、遗传因素、肥胖、吸烟等Table—RiskFactorsforVTESurgeryTrauma(majororlowerextremity)Immobility,paresisMalignancyCancertherapy(hormonal,chemotherapy,orradiotherapy)PreviousVTEIncre

7、asingagePregnancyandthepostpartumperiodEstrogen-containingoralcontraceptionorhormonereplacementtherapySelectiveestrogenreceptormodulatorsAcutemedicalillnessHeartorrespiratoryfailureInflammatoryboweldiseaseNephroticsyndromeMyeloproliferativedisordersParoxysmalnocturnalhemogl

8、obinuriaObesitySmokingVaricoseveinsCentralvenouscatheterizationInheritedoracquired