肺栓塞全套课件.pptVIP

圖12000年8月27日（急診）ECG大致正常2000年8月29日（門診）ECG示IRBBBSⅠQⅢTⅢV1V2T波倒置V3V4T波雙向二、X線胸片急性PTE患者的胸片除少見的肺陰影或胸腔積液外，最為常見的是肺紋理稀疏，區域性肺透過度增強和肺血分佈不勻。肺梗死時可見肺周圍浸潤性陰影，形狀不一常累及肋膈角，也可出現盤狀肺不張。肺栓塞胸片檢查PeerReviewStatus:ExternallyPeerReviewedbytheAMAX-RAYFORCHESTAtelectasisandparenchymal.AtelectasisaremorecommoninthelowerlobeasaretheareasofparenchymaldensityMostofthesedensitiesarecausedbypulmonaryhemorrhageandedemaandcanbeconfusedwithinfectiousinfiltratesormalignantmassesPleuraleffusionsarecommonandmostoftenunilateraldespitethefactthatmostclotsarebilateral.Theseeffusionsareusuallyvisiblewhenthepatientseeksmedicalattention.Theyarealmostalwayssmall,occupyinglessthan15%ofahemithoraxandrarelyincreaseinsizeafter3days.Anyincreaseinsizeafter3or4daysshouldraisethesuspicionofapulmonaryinfectionorre-embolization.PleuralbasedopacitieswithconvexmedialmarginsarealsoknownasaHamptonsHump.Thismaybeanindicationoflunginfarction.However,thatrateofresolutionofthesedensitiesisthebestwaytojudgeiflungtissuehasbeeninfarcted.Areasofpulmonaryhemorrhageandedemaresolveinafewdaystooneweek.Thedensitycausedbyanareaofinfarctedlungwilldecreaseslowlyoverafewweekstomonthsandmayleavealinearscar.Thecentralpulmonaryarteriesmaybeprominenteitherfrompulmonaryhypertensionorthepresenceofclotinthosearteries.三、超聲心動圖直接徵象:為主肺動脈及左、右肺動脈主幹存在血栓回聲間接徵象：右心房、室擴大，室間隔左移，左室由橢圓形變為“D”字形，右室壁收縮減弱，三尖瓣返流、跨瓣壓差增加，以及估測肺動脈壓增高等。Color-Flow-Doppler-ultrasound

非擠壓性充盈缺損四、血氣分析是診斷肺栓塞可能有用的篩選方法。肺栓塞患者多有PaCO2下降，PH升高，肺泡-動脈血氧分壓差（PA-aDO2）增加，PaO2下降或正常；當血管床堵塞15%—20%時可出現低氧血症，發生率約76%。93%有低碳酸血症；86%—95%有（PA-aDO2）增大，後二者正常有助於排除較大肺栓塞。五、D-二聚體很難用這項指標指導臨床。六、核素檢查據不完全統計，國內有超過1/3的醫院在目前仍不能進行此項檢查。七、肺動脈造影：是PTE診斷的“金標準”不首選。正常肺動脈造影肺血栓栓塞一、基本概念深靜脈血栓形成（DVT）：纖維蛋白、血小板、紅細胞等血液成分在深靜脈系統血管腔內形成凝血塊。PTE:70%-90%的栓子來源於DVT，而有DVT的患者中