培训课件-肺栓塞指南解读.pptVIP

* Chronic thromboembolicpulmonary hypertension 去分析或识别不同的诱发因素不仅对诊断PE有帮助，还会影响后期的抗凝治疗方案，有些无法去除诱因的可能需要终生抗凝。 呼吸末正压会降低静脉回心血量，加重右心衰 * 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism * 2014vs(2000 or 2008) (1) Initial risk stratification (2) Thrombolytic treatment (3) New oral anticoagulants (4) Chronic thromboembolic pulmonary hypertension * Epidemiology difficult to determine： remain asymptomatic diagnosis may be an incidental finding sudden death * Epidemiology over 317 000 deaths were related to VTE in six countries of the European Union (with a total population of 454.4 million) in 2004: 34% presented with sudden fatal PE 59% were deaths resulting from PE that remained undiagnosed during life 7%of the patients who died early were correctly diagnosed with PE before death. (Cohen AT, Venousthromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98(4):756–764.) * Predisposing factors surgery trauma immobilization pregnancy oral contraceptive use hormone replacement therapy cancer obesity infection and central venous lines * Pathophysiology Acute PE interferes with circulation and gas exchange Right ventricular (RV) failure is considered the primary cause of death in severe PE * Clinical classification of pulmonaryembolism severity Replace “massive PE sub-massive PE submassive PE” * Diagnosis Clinical presentation non-specific * Assessment of clinical probability * Assessment of clinical probability * D-dimer testing the negative predictive value is high the positive predictive value is low（cancer, inflammation, bleeding, trauma, surgery and necrosis） age-adjusted cut-offs (age x 10 mg/L above 50 years) increasing specificity from 34–46% and sensitivity above 97% （Schouten HJ. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism:systematic revie