第8章： 肺血栓栓塞.pptVIP

Hamptons Hump PE which appears like a mass PE with effusionand elevated diaphragm 超声心动图 右心室扩大 间隔左移 左心室变小，呈Ｄ字形 右心室运动减弱 肺动脉增宽 三尖瓣返流 肺动脉高压 Ventilation-perfusion scanning 通气/灌注扫描 Useful if the results are normal or near normal As many as 40% of pts with high clinical suspicion for PE and low probability scans have a PE on angiogram 正常灌注扫描可除外PTE Ventilation-perfusion scanning 通气/灌注扫描 Spiral CT CT angiography CT和CT血管成像 Pulmonary Angiogram Most specific test available for diagnosis of PE Can detect emboli as small as 1-2 mm Most useful when the clinical likelihood of PE differs substantially from the lung scan result or when the lung scan is intermediate probability 肺动脉造影显示正常左肺动脉 Examinations of DVT 深静脉血栓形成的检查 Contrast venography: a gold standard 静脉造影：金标准 Duplex ultrasonography 超声多普勒 Impedance plethysmography 静脉阻抗图测定 放射性核素静脉造影 Diagnosis Differential diagnosis诊断和鉴别诊断 重视发病诱因 血栓性静脉炎 长期卧床 下肢和盆腔静脉血栓 不活动（乘机、乘车） 慢性心肺疾病 手术、创伤恶性肿瘤、肥胖症 血液病、妊娠、服避孕药 重要的临床线索 胸闷 原因不明的劳力性呼吸困难 不能解释的低热 原有疾病的突然变化 心力衰竭对洋地黄制剂反应差 下肢静脉的检查 双侧下肢周径相差＞1 CM 肺血栓栓塞 Pulmonary Thromboembolism Definitions 定义 Risk Factor 危险因素 Pathology 病理学 Pathophysiology 病理生理学 Clinical Manifestations 临床表现 Laboratory Testing Special Testing 实验室和特殊检查 Diagnosis Differential diagnosis 诊断和鉴别诊断 Treatment 治疗 Definitions 定义 Pulmonary Embolism (PE) 肺栓塞 Pulmonary Thromboembolism (PTE) 肺血栓栓塞 Pulmonary Infarction (PI) 肺梗死 Venous Thromboembolism 静脉血栓栓塞 60% to 90% of PEs originate from DVT As a thrombus breaks free, it travels to the heart and obstructs branches of the pulmonary arterial tree. Large clots may remain lodged in the central pulmonary artery as saddle emboli, while small emboli may travel to peripheral sub segmental arteries. Risk Factors 危险因素 Inherited Acquired Age Obesity Smoking Oral contraceptives Pregnancy Surgery Trauma History of DVT Hormonal therapy Immobility Central venous Catheter Medical Conditions Pathology 病理学 B