人工瓣膜血栓诊断和治疗.ppt

LOGO LOGO 人工瓣膜血栓诊断与治疗 汇报内容 人工瓣膜血栓的形成 人工瓣膜血栓的诊断 人工瓣膜血栓的治疗 总结 溶栓治疗 人工瓣膜血栓的形成 人工瓣膜血栓是瓣膜置换术后的严重并发症之一。 发生率：～10%/年 发达国家：0.3%-1.3% 发展中国家：6.1% 机械瓣（主动脉瓣+二尖瓣）：0.5%-8% 机械瓣（三尖瓣）：20% 生物瓣：0.03%  Gursoy Mo. et al. The current status of fluoroscopy and echocardiography in the diagnosis of prosthetic valve thrombosis–a review article. Echocardiography. 2015, 32: 156-164 人工瓣膜血栓形成的高危因素 怀孕 抗凝不足 心室功能障碍 多个瓣膜置换 房颤 左房增大 高危 Gursoy Mo. et al. The current status of fluoroscopy and echocardiography in the diagnosis of prosthetic valve thrombosis–a review article. Echocardiography. 2015, 32: 156-164 人工瓣膜血栓的危害 F.M. Castilho et al. Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta-analysis. J thromb Haemost , 2014, 12:1218-28 人工瓣膜血栓的评估和管理 呼吸困难、栓塞事件 二尖瓣/主动脉瓣 三尖瓣/肺动脉 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease Ⅰ级：患者有心脏病，但日常活动量不受限制，一般体力活动不引起过度疲劳、心悸、气喘或心绞痛。 Ⅱ级：心脏病患者的体力活动轻度受限制。休息时无自觉症状，一般体力活动引起过度疲劳、心悸、气喘或心绞痛。 Ⅲ级：患者有心脏病，以致体力活动明显受限制。休息时无症状，但小于一般体力活动即可引起过度疲劳、心悸、气喘或心绞痛。 Ⅳ级：心脏病患者不能从事任何体力活动，休息状态下也出现心衰症状，体力活动后加重。 经胸彩超 经食道彩超 左侧血栓的治疗策略 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease 2012 ACCP-9:Antithrombotic and Thrombolytic Therapy for Valvular Disease 2012 ESC/EACTS Guidelines on the management of valvular heart disease 人工瓣膜血栓的治疗 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease 溶栓方案 Raymond et al. Fibrinolysis of Mechanical Prosthetic Valve Thrombosis A Single-Center Study of 127 Case. JACC, 2003, 41(4): 653-8 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease 溶栓的疗程 G. Karthikeyan el at. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis. 2011, 32: 146-149 溶栓效果的评价 Ganasan Karthikeyan, et al. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta