肺动脉栓塞的诊治.pptx

肺动脉栓塞的诊治;基本概念;肺栓塞的现状;Epidemiology;流行病学;生存率比较;RiskFactorsforDVT/PulmonaryEmbolism（Essential）;RiskFactorsforDVT/PulmonaryEmbolism（Second）;深静脉血栓形成;肺血栓与深静脉血栓;肺栓塞的大体解剖观;肺栓塞的显微镜下观;肺栓塞的病理生理;肺栓塞后右心功能不全的病生;肺栓塞后肺血流动力学变化;呼吸动力学改变;临床分型;症状;体征;D-二聚体分析;肺栓塞胸片检查;X-RAYFORCHEST;;;PleuralbasedopacitieswithconvexmedialmarginsarealsoknownasaHamptonsHump.Thismaybeanindicationoflunginfarction.However,thatrateofresolutionofthesedensitiesisthebestwaytojudgeiflungtissuehasbeeninfarcted.Areasofpulmonaryhemorrhageandedemaresolveinafewdaystooneweek.Thedensitycausedbyanareaofinfarctedlungwilldecreaseslowlyoverafewweekstomonthsandmayleavealinearscar.

;;;;AWestermarkssignimpliesanareaofdecreasedvascularityandperfusionaccompaniedbyanenlargedcentralpulmonaryarteryontheaffectedside.

;肺栓塞的心动超声征象;室间隔异常活动;Color-Flow-Doppler-ultrasound

;心电图表现;图12000年8月27日（急诊）ECG大致正常;Ventilation/PerfusionLungScan

;PIOPED：肺扫描分类与肺动脉造影结果的比较;肺扫描;典型肺栓塞;不典型肺栓塞;Itishighsensitivitybutlowspecificity;;;Conclusion;CTofPulmonaryEmbolism;Theapexofthetriangleisoftentruncatedandnotwedgeshapedwhichcorrespondstothenormalconfigurationofasecondarylobuleinthelungperiphery.Lowattenuationareaswithintheinfarctrepresentsviablelung.

Itisimportanttonote,however,thatthisappearanceisnotspecificforpulmonaryinfarction.Thedifferentialdiagnosisforthisabnormalityincludesinfarct,hemorrhage,pneumonia,fibrosis,neoplasiaandedema

;;;肺动脉造影;;Themostreliablesignsofpulmonaryembolusare:

AnIntraluminalfillingdefect

AnAbruptterminationofabranchvessel;Conclusion;TheDiagnosisAlgorithm;InterpretationCriteria

;LowProbability(0-19%likelihoodforPE);DiagnosticCriteriaforClinicallySuspectedPulmonaryEmbolism;鉴别诊断;原发性肺动脉高压与肺栓塞复发;区别点;急性PE的治疗;呼吸循环支持治疗;溶栓治疗的适应证;溶栓禁忌证;肺动脉栓塞的溶栓及抗凝治疗;依据体重的肝素（普通）计算图;???腔静脉过滤网适应证;肺动脉血栓摘除术;经静脉导管碎解和抽吸血栓;慢性栓塞性肺动脉高压的治疗;预防策略