肺栓塞的诊断与治疗新研究.docVIP

肺栓塞的诊断与治疗新研究 　　摘要：肺栓塞（pulmonary embolism，PE）作为严重威胁人类生命的疾病，临床表现形式多样，且缺乏特异性，误诊率高。常用的无创诊断手段包括心电图、胸部X线、D-二聚体定量、血气分析、心脏超声、CT肺血管成像及核素肺通气灌注扫描等。有创检查主要是肺血管造影。CT肺血管成像已经逐步被认为是取代肺血管造影的无创检查之首选。肺栓塞的主要治疗包括病因干预、抗栓治疗、外科治疗及并发症对症支持等治疗。对急性大面积血栓患者，溶栓治疗疗效优于单纯抗凝，抗凝治疗是肺栓塞的基础治疗。 　　关键词：肺栓塞；诊断；治疗 　　Diagnosis and Treatment Progress of Pulmonary Embolism 　　MA Zhi-ying1，CAI Chang-ma2，LI Yan-jie3 　　（1.Department of Respiratory Medicine，Binzhou Central Hospital，Binzhou 251700，Shandong，China；2.Department of Orthopedics，Binzhou Central Hospital，Binzhou 251700，Shandong，China；3.Department of Respiratory Medicine，Maternal and Child Care Service Centre，Tangshan City Second Peoples Hospital，Tangshan 063000，Hebei，China） 　　Abstract：Pulmonary embolism （pulmonary embolism， PE） as a serious threat to the health and life of human beings， clinical manifestations， and lack of specificity， the high rate of misdiagnosis. Commonly used noninvasive diagnostic methods including ECG， chest X-ray， D one or two dimer quantitative， blood gas analysis， cardiac ultrasound， CT pulmonary angiography and radionuclide pulmonary ventilation perfusion scan. Invasive examination is mainly pulmonary angiography. CT pulmonary angiography have been considered to be the first choice to replace the noninvasive pulmonary angiography. The main treatment of pulmonary embolism included cause intervention， antithrombotic therapy， surgical treatment and complications of symptomatic and supportive treatment. Of the patients with acute large area of thrombosis， thrombolytic therapy effect is better than pure anticoagulation， anticoagulant therapy is the basic treatment of pulmonary embolism. 　　Key words：Pulmonary thromboembolism ；Diagnosis； Treatment 　　肺栓塞（PE）是内源性或外源性栓子阻塞肺动脉及其分支引起肺循环障碍的临床和病理生理综合征，包括肺血栓栓塞症、脂肪栓塞、羊水栓塞、空气栓塞等。其中肺血栓栓塞症是肺栓塞最常见的类型[1]，占肺栓塞的绝大多数。肺血栓栓塞症（pulmonary thromboembolism，PTE）是来自静脉系统或右心的血栓阻塞肺动脉或其分支引起肺循环障碍的临床和病理生理综合征。引起PTE的血栓主要来源于深静脉血栓（DVT），常为DVT的并发症。深静脉血栓形成（DVT）是纤维蛋白、血小板、红细胞等血液成分在深静脉管腔内形成凝血块（血栓），DVT和PTE实质上为同一种疾病的不同阶段、