肺栓塞指南解读课件.ppt

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1、2014ESCGuidelinesonthediagnosisandmanagementofacutepulmonaryembolism12014vs(2000or2008)(1)Initialriskstratification(2)Thrombolytictreatment(3)Neworalanticoagulants(4)Chronicthromboembolicpulmonaryhypertension2Epidemiologydifficulttodetermine：remainasymptomaticdiagnosismaybeaninciden

2、talfindingsuddendeath3Epidemiologyover317000deathswererelatedtoVTEinsixcountriesoftheEuropeanUnion(withatotalpopulationof454.4million)in2004:34%presentedwithsuddenfatalPE59%weredeathsresultingfromPEthatremainedundiagnosedduringlife7%ofthepatientswhodiedearlywerecorrectlydiagnosedwit

3、hPEbeforedeath.(CohenAT,Venousthromboembolism(VTE)inEurope.ThenumberofVTEeventsandassociatedmorbidityandmortality.ThrombHaemost2007;98(4):756–764.)4Predisposingfactorssurgerytraumaimmobilizationpregnancyoralcontraceptiveusehormonereplacementtherapycancerobesityinfectionandcentralven

4、ouslines5PathophysiologyAcutePEinterfereswithcirculationandgasexchangeRightventricular(RV)failureisconsideredtheprimarycauseofdeathinseverePE6ClinicalclassificationofpulmonaryembolismseverityReplace“massivePEsub-massivePEsubmassivePE”7DiagnosisClinicalpresentationnon-specific8Asses

5、smentofclinicalprobability9Assessmentofclinicalprobability10D-dimertestingthenegativepredictivevalueishighthepositivepredictivevalueislow（cancer,inflammation,bleeding,trauma,surgeryandnecrosis）age-adjustedcut-offs(agex10mg/Labove50years)increasingspecificityfrom34–46%andsensitivitya

6、bove97%（SchoutenHJ.DiagnosticaccuracyofconventionalorageadjustedD-dimercut-offvaluesinolderpatientswithsuspectedvenousthromboembolism:systematicreviewandmeta-analysis.BMJ2013;346:f2492）11D-dimertesting12Computedtomographicpulmonaryangiography（CTPA）13Pulmonaryangiographygoldstandardr

7、arelyperformednowusedtoguidepercutaneouscatheter-directedtreatmentofacutePE.Thrombiassmallas1–2mmwithinthesub-segmentalarteriescanbevisualizedbyDSA14SpecialimagingexaminationLungscintigraphyMagneticresonanceangiographyEchocardiography：RVpressureoverloadanddysfunctionCompressionvenou

8、sultrasonography:DV