8肺血栓栓塞PPT.ppt

肺血栓栓塞症;概论;;Fat embolization syndrome occurs most often following trauma with fracture of long bones. ;Amniotic fluid embolization can have the same outcome as a large pulmonary embolus.;流行病学;危险因素;; The thromboemboli typically originate in the leg veins or pelvic veins of persons who are immobilized. ;“Saddle embolus bridges across the pulmonary artery from the heart as it divides into right and left main pulmonary arteries. ; The infarct is wedge-shaped and based on the pleura. These infarcts are hemorrhagic because the pulmonary artery carrying most of the blood.;Virchow’s triad Venous stasis, Venous endothelial injury, Hypercoagulability.;病理生理;;;临床表现;血气示低氧血症、低碳酸血症，肺泡-动脉氧分压差增大； EKG：V1-V4T波倒置，I导联S波+Ⅲ导联Q波+Ⅲ导联T波倒置、右束支传导阻滞、肺型P波、电轴右偏及顺钟向转位； X线：区域性肺纹理变细、右下肺动脉增宽或截断征，肺动脉段膨隆，右心室扩大；尖端??向肺门的楔形阴影； ;Electrocardiogram showing transient right bundle branch block in a case of massive pulmonary embolism. ;; Frontal radiograph of the chest shows an enlarged main pulmonary arteryand a markedly enlarged right and left pulmonary arteries. The peripheral vasculature is normal ; Oligemia Diffuse, decreased attenuation throughout the right lung, consistent with oligemia secondary to acute pulmonary embolism. ;Pulmonary Infarction Wedge-shaped, subpleural consolidation (Hamptons hump) in the right lower lobe, due to pulmonary infarction. ;;血浆D-二聚体，急性PTE时升高； ; 放射性核素肺通气/灌注扫描 肺段分布的肺灌注缺损；;;;;CT pulmonary angiography ;;;鉴别诊断; 男性，56岁，右上臂挫伤3天后感胸部不适，气促，氧饱和度下降。;胸片(6月11日);肺灌注扫描（6月13日） ;肺血栓栓塞症临床分型;一般处理;溶栓治疗;抗凝治疗;;