培训课件-倪兆慧NS血栓防治普陀讲课交稿.pptVIP

法安明肾科学术论坛 There is a very strong association between pulmonary embolism (PE) and deep vein thrombosis (DVT): - 90% of pulmonary emboli are the results of DVT - A recent study showed that 82% of patients with acute PE had detectable DVT at the time PE was diagnosed. - Silent PE occurs in more than 50% of patients with symptomatic proximal DVT. As the venous clot in the leg grows it extends along the vein. DVT can develop into a chronic condition in which damage to the valves in the veins results in swelling of the leg, pain and venous hypertension (known as post-thrombotic syndrome - PTS) Parts of the clot can also detach, travelling in the blood to block vessels in the lungs, subsequently causing pulmonary embolism (PE). If less than 50% of the pulmonary circulation is blocked, symptoms are generally limited to shortness of breath or are absent altogether. Very large emboli, however, can cause massive blockage of the pulmonary circulation and rapidly lead to death. 1. Pesavento R, Lusiani L, Visona A, et al. Prevalenza di embolia polmonare clinicamente silente nella trombosi venosa profonda degli arti inferiori. Minerva Cardioangiologica 1997;45:369-375. 2. Girard P, Musset D, Parent F, Maitre S, Phlippoteau C, Simmonneau G. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116:903-908. * * 法安明肾科学术论坛 肾病综合征相关血栓栓塞性疾病的诊治 倪兆慧 上海交通大学附属仁济医院肾脏科 肾病综合征血栓栓塞发生率 疾病分类 例数 RVT % 膜性肾病 26 12 46.2 系膜增生性肾炎 22 10 45.5 IgA肾病 10 4 40 微小病变肾病 14 7 50 膜增殖性肾炎 3 0 肾局灶硬化 2 1 肾增生硬化或局灶增生硬化 2 2 其他原发肾小球病 4 1 狼疮肾炎 11 6 54.5 肾淀粉样变 3 2 过敏性紫癜 3 1 合计 100 46 46 程蕙芳等。中华医学杂志 1992；72（7）：416-419 NS是VTE的危险因素 The American Journal of Medicine, 2008, 121:226-230 致命肺栓塞例： 近50％在濒临死亡前检查出来 约80%DVT患者无临床症状 静脉血栓栓塞：通常不被察觉 PE: 住院病人中更为常见 住院病人 PE发生率比一般人群高10倍 3级医院PE年发生率(占住院例次%) 0–9 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80–89 年龄 (岁) 0.5 0.4 0.3 0.2 0.1 0 1. Stein PD, et al. Chest 1999;116:909-913 2. Anderson F Jr, et al. Arch Intern Med