2008ESC急性肺动脉栓塞指南解读.pptVIP

Guidelineson

thediagnosisandmanagement

ofacutepulmonaryembolism——2008ESC

Classesofrecommendations

Levelsofevidence

PredisposingfactorsPredisposingfactorsforvenousthromboembolism:Table3

NaturalhistoryTheriskofVTEaftersurgeryishighestduringthefirst2weeksaftersurgerybutremainselevatedfor2–3months.AntithromboticprophylaxissignificantlyreducestheriskofperioperativeVTE.Thelongerthedurationofantithromboticprophylaxis,thelowertheincidenceofVTE.

shockorhypotensionin5–10%ofcases,andinupto50%ofcaseswithoutshockbutwithlaboratorysignsofrightventriculardysfunction(RVD)and/orinjury,whichindicatesapoorerprognosis.completeresolution;two-thirdsofallpatientswithoutanticoagulation,about50%,within3monthsanticoagulationtreatmentatleast3-12monthsofanticoagulationtreatment

PathophysiologyTheconsequencesofacutePEareprimarilyhaemodynamicandbecomeapparentwhen30–50%ofthepulmonaryarterialbedisoccludedbythromboemboli.Largeand/ormultipleembolimightabruptlyincreasepulmonaryvascularresistancetoalevelofafterloadwhichcannotbematchedbytherightventricle(RV).Suddendeath:Electormechanicaldissociationsyncopeand/orsystemichypotension

PathophysiologyPatientssurviving:activatethesympatheticsystemrestingpulmonaryflow,leftventricularfillingandoutput,Togetherwithsystemicvasoconstriction,RVcoronaryperfusionandthefunctionoftheRVSecondaryhaemodynamicdestabilizationmayoccur,usuallywithin?rst24–48h,recurrentemboliordeteriorationofRVfunctionincreasedRVmyocardialoxygendemandanddecreasedRVcoronaryperfusionRespiratoryinsuf?ciencyinPEispredominantlyaconsequenceofhaemodynamicdisturbances.

SeverityofpulmonaryembolismPrincipalmarkersusefulforriskstratificationinacutepulmonaryembolismTable4R