日本肺栓塞及深静

《日本肺栓塞及深静》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、日本肺栓塞及深静脉血栓指南2011版流行病学发病率逐渐升高美国500/百万，日本62/百万2006年，围手术期4.41-2.79，女性发病率增高较快，好发年龄60-70岁。危险因素Interruptedbloodflow长期卧床肥胖怀孕心肺疾病(如充血性心力衰竭、慢性肺心病等)全麻下肢麻醉下肢制动下肢静脉曲张Endothelialdysfunction手术外伤、骨折中心静脉置管导管介入检查或治疗血管炎抗磷脂综合症Hyperhomocysteinemia（高同型半胱氨酸血症，遗传或获得性）Hypercoagulability恶性肿瘤怀孕手术、创伤、骨折烧伤药物(如口

2、服避孕药、雌激素等)感染肾病综合征炎性肠病骨髓增生性疾病，红细胞增多症阵发性睡眠型血红蛋白尿抗磷脂综合症脱水抗凝酶缺乏蛋白C缺乏蛋白S缺乏纤溶酶原异常纤维蛋白原异常组织纤溶酶原活化抑制因子增多血栓调节素异常蛋白C活化抵抗凝血酶原基因变异(G20210A)*症状、体征缺乏特异性呼吸困难、胸痛典型者是起床活动、排便排尿或体位改变时出现严重程度的判别血流动力学心脏超声检查右心负荷增重心脏骤停、休克心脏骤停、休克有大面积不稳定、低血压或休克（收缩压低于90或较基础血压下降大于等于40）有次大面积稳定有非大面积稳定无急性肺栓塞诊断步骤Startheparintherapyw

3、henpulmonaryembolismissuspected.Examinefordeepveinthrombosisatonce.*1ScreenthepatientwithchestX-ray,ECG,arterialbloodgasanalysis,transthoracicechocardiography,andbloodchemistry.*2WhenPCPSisnotavailable,maintaincirculationwithcardiaccompressionandvasopressors.CT,computedtomography;PCPS

4、,percutaneouscardiopulmonarysupport.AdaptedfromTherapeuticResearch2009;30:744–747.处理程序*1Whenriskofbleedingishigh.*2Treatcomplicationsappropriatelywithavailablemethods.*3Unstablehemodynamicsconsistentwithshockorprolongedhypotension.*4Conditionrequiringcardiopulmonaryresuscitationorprol

5、ongedsevereshock.*5ConsiderPCPSaccordingtohospitalequipmentsandpatientcondition.*6Selectappropriatetreatmentaccordingtohospitalequipmentsandpatientcondition.*7Evaluatebasedonrightventricularenlargementonechocardiographyandseverityofpulmonaryhypertension.*8Presence/absenceofDVTwhichmay

6、haveseriouseffectsifitreleasesembolicausingrecurrentembolism.Theabovealgorithmisanexample.Eachinstitutionshouldselectappropriatemethodsaccordingtoitshealthcareresources.DVT,deepveinthrombosis;PCPS,percutaneouscardiopulmonarysupport;IVC,inferiorvenacava.肝素抗凝剂量调整及监测普通肝素首剂5,000units静滴,继以

7、1,400units/hr的速度持续维持.首剂后6hr监测APTT，按照上表调整剂量*1UsethistableforAPTTreagentswithatherapeuticrangeof1.9to2.7timesthecontrol.*2Whenunfractionatedheparinisadministeredataconcentration40units/mL.APTT,activatedpartialthromboplastintime;Bolus,bolusdoseforrepeatedadministration;Hold,durationofsus

8、pensi