肺动脉栓塞致矛盾性脑栓塞临床分析.docVIP

肺动脉栓塞致矛盾性脑栓塞临床分析 　　【摘要】目的 探讨肺动脉栓塞（PE）合并脑动脉栓塞的诊断与治疗方法。方法 回顾性分析2007年10月至2011年7月厦门大学附属中山医院5例肺动脉栓塞合并脑动脉栓塞的临床资料，并复习有关文献。结果 5例患者均为女性，平均年龄为46.5岁，均通过增强肺部CT及肺ECT证实为肺动脉栓塞，经超声心动图检查发现均有中-重度肺动脉高压，2例卵圆孔未闭，1例为先天性房间隔缺损。5例患者均经头部MRI诊断为新发脑梗死。3例采用溶栓治疗，5例均给予抗凝治疗。 5例患者经治疗均存活，且长期服用华发令，INR控制在2.0～2.5之间，1例患者脑栓塞3 d后再次出现脑栓塞， 4例患者随访未再次发生体循环系统栓塞。结论 矛盾性脑栓塞并非少见，应加强诊断意识。对于肺动脉栓塞，尤其是肺动脉高压合并体循环动脉栓塞或不明原因的脑动脉栓塞，应考虑到矛盾性栓塞可能。 　　【关键词】肺动脉栓塞???矛盾性脑栓塞；诊断 　　Clinical analysis of paradoxical cerebral embolism from pulmonary embolism GE Hua， ZHENG Wei-hong，WANG Yong-jian，ZHU Ren-jing. Department of Neurology， Zhongshan Hospital Xiamen University， Xiamen 361004， China 　　Corresponding author： ZHENG Wei-hong， Email： gehua701121@163.com 　　【Abstract】Objective To explore the diagnosis and treatment of cerebral embolism from pulmonary embolism （PE）. Methods The clinical data of 5 cases with PE accompanied by cerebral embolism covering a period from October of 2007 to July of 2011 were retrospectively analyzed. Results In this study， the average age of 5 cases （all female） was 46.5 years old. PE was diagnosed through enhanced CT and ECT in lung among all 5 cases. Moderate to severe pulmonary hypertension was confirmed by echocardiogram. Two cases was patent foramen ovale and one was congenital atrial septal defect. Each patient was diagnosed to be new-onset cerebral infarction by MRI. Three cases underwent cerebral arterial thrombolysis. All of them survived and long-term anticoagulant treatment with Warfarin. INR was adjusted between 2.0 and 2.5 by change of Warfarin dose. Among them， one patient had cerebral embolism again just 3 days after the latest cerebral embolism； the other 4 patients did not suffer from cerebral embolism during the follow-up. Conclusions Paradoxical cerebral embolism is common. For clinical patients with PE， especially pulmonary hypertension accompanied by systemic circulation arterial embolism or unexplained systemic cerebral arterial embolism， paradoxical cerebral embolism should be consider