PULMONARYEMBOLISM-f.ppt

PULMONARY EMBOLISMCurrent Diagnostic strategies David McFadden, MD, MPH Mayo Clinic USA PREVALENCE流行病学 500,000 cases per year in USA 美国每年有500，000例患者 200,000 deaths 200，000患者死亡 50% of cases undiagnosed; often autopsy dx. 50%的患者被误诊或漏诊；经常由尸检明确 30% mortality rate without treatment 未经治疗的患者，有30%的死亡率 2-8% mortality with treatment 经过治疗的患者，有2-8%的死亡率 Thromboembolic Disease Risk Factors I血栓栓塞疾病的危险因素一 Case-control study of 625 Olmsted County residents (1976-1980): 病例对照研究 Odds Ratio - Surgery 外科手术 21.7 - Trauma 创伤 12.7 - Hospital or NH confinement 住院或制动 8.0 - Malignancy with chemotherapy 恶性肿瘤化疗 6.5 - Malignancy without chemotherapy 恶心肿瘤未化疗 4.1 - Central line or pacemaker 中心置管或起搏器 5.6 - Superficial phlebitis 浅表静脉炎 4.3 - Stroke with paresis 中风伴轻瘫 3.0 - Liver disease 肝脏疾病 0.1 (Arch Intern Med 2000; 160:809-815) Thromboembolic Disease Risk Factors II血栓栓塞疾病的危险因素一 Retrospective study of 2218 Olmsted County residents (1966-1990): 回顾性研究 Age 年龄 Incidence Per 100,000 发病率 0 - 14 1 15 - 24 20 25 - 34 30 35 - 44 40 45 - 54 70 55 - 64 145 65 - 74 300 75 - 84 800 (Arch Intern Med 1998; 158:585-593) Risk Factors for PE肺栓塞的危险因素 Immobilization (prolonged bedrest) 制动（长期卧床） Recent surgery (within 3 months) 近期手术史（三个月内） Stroke 中风 Prior history of venous thromboembolism 既往静脉血栓栓塞史 Malignancy (pancreatic or prostate Ca) 恶心肿瘤（胰腺癌或前列腺癌） Idiopathic PE—Coagulation defects 原发性肺栓塞– 凝血缺陷 Factor V Leiden mutation (40% of cases) 因子V莱顿突变（ 40% 的病例） High factor VIII (6 X increased risk for DVT) 因子VIII 升高（深静脉血栓的危险性增加6倍） Pathophysiology病理生理 Pulmonary emboli due to DVT in lower ext. 肺栓塞的栓子来自下肢深静脉血栓脱落 May also come form pelvic, renal, or upper ext. veins and right heart 也可能来自盆腔，肾，或者上肢静脉和右心 Ileofemoral thrombi source of most clinically recognized PE 大部分临床识别的肺栓塞的栓子来自髂股部位 M