[医药卫生]肺拴塞.ppt

pulmonaryartery embolism Dalian medical university Emergency Department 一.definition: pulmonary artery embolism是内源性endogenous或外源性ectogenesis栓子堵塞肺动脉或其支引起肺循环障碍circulatory disorder的临床和病理生理综合征，又称肺血栓栓塞病pulmonary thrombo-embolic disease. 临床上最常见的血栓来自下肢深静脉deep vein of lower limbs及盆腔静脉vein of cavitas pelvis。 二. incidence rate 美国每年约70万以上人患有症状的肺栓塞pulmonary artery embolism 我国肺栓塞诊断逐年增高，北京协和医院生前确诊率7.8%。 base disease 1、eld 2、heart disease 3、adipositas 4、tumour 5、pregnancy and parturition 6、long-term bed 7、drugs 8、deep vein thrombosis 三.Pathogeny and Pathophysiology Types of embolia: 1.thrombus embolism 2.fat embolism 3. amnionic fluid embolism 4.air embolism 5.tumor and bacterial embolus the lower limbs and cavitas pelvisdeep vein thrombosis about 68% Chronic heart and lung disease and malignant neoplasm After interventional therapy congenital defects of blood clotting and fibrinolysis pathology 1、acute large pulmonary artery embolism 2、骑跨型血栓 3、acute hypolarge pulmonary artery embolism 4、moderately Pulmonary embolism 5、micro-Pulmonary embolism Pathophysiology the distinguish of lung infarct and pulmonary artery embolism 肺梗死存在局部组织缺血、坏死 1、change of respiration physiology 肺泡无效腔增大 通气受限 loss of alveolar surfactant anoxemia 2、the change of blood stream blood stream loss of pulmonary vascular bed，resistance of pulmonary artery increase and right cardiac load increase. 3、change of neurohumor platelet activating factor Thromboxane A2 catecholamine 5-hydroxytryptamine inducement: 静脉内压发生急剧变化或静脉血流blood stream of vein量明显增加，均可造成血栓部分和完全脱落。 Exertion defecation exertion suddenly movement after long-term bed predilection site: 1、right lungleft lung、下肺上肺 2、bothside lungsingleb lung pathogenesis the mechanism of deep vein thrombosis 1、blood stream stagnant 2、abnormality of vessel wall 3、blood viscosity increase pathogenesis pulmonary artery embolism 肺血管床血流急剧减少.肺A痉挛、肺血管阻力增加、肺A高压 右心负荷增加、右心衰左心