肺动脉血栓内膜剥脱术后再灌注肺水肿的进展

肺血栓栓塞症是一种常见、多发且病死率和致残率高的疾病。大多数急性肺动脉血栓栓塞经及时的溶栓抗凝等治疗和 (或 )自身的纤溶系统能将血栓不同程度地溶解 ,另有0 1%～ 0 2 %的患者因血栓在急性期未能溶解或栓塞反复发生进而发展成慢性栓塞性肺动脉高压。慢性栓塞性肺动脉高压溶栓无效 ,抗凝、扩血管治疗效果不佳 ,其病理过程多呈进行性加重或稳定一段时间后再次加重 ,自然预后差。肺动脉平均压 >3 0ｍｍＨｇ(1ｍｍＨｇ =0 13 3ｋＰａ)的慢性栓塞性肺动脉高压患者 5年生存率为 3 0 % ,肺动脉平均压 >5 0ｍｍＨｇ者仅为 10 %。肺动脉血…     

慢性血栓栓塞性肺动脉高压新治疗方法的进展

慢性血栓栓塞性肺动脉高压是由于肺动脉血栓未完全溶解导致的一类毛细血管前性肺动脉高压.肺动脉内膜剥脱术是目前慢性血栓栓塞性肺动脉高压的首选治疗方案.但很多患者因远端血管病变或严重合并症而无法手术,或手术后有持续性肺动脉高压,球囊肺血管成形术和靶向药物的发展为这些患者的治疗带来了新的希望.现就慢性血栓栓塞性肺动脉高压新疗法...     

书讯

<正>由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

书讯

正由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

肺栓塞的药物治疗

肺栓塞的药物治疗主要包括溶栓和抗凝,目的是缩小或消除深静脉和肺动脉血栓,控制栓塞所致心肺功能紊乱,防治复发及慢性血栓栓塞性肺动脉高压发生。     

书讯

<正>由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

书讯

正由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

书讯

正由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

书讯

正由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

慢性血栓栓塞性肺动脉高压的靶向药物治疗

慢性血栓栓塞性肺动脉高压（CTEPH）是一种可能被治愈的肺动脉高压,部分患者可通过肺动脉血栓内膜剥脱术（PEA）达到治愈。但有半数以上的患者不适宜行该手术,或手术后仍有持续性或复发性肺动脉高压,对于这些患者,利奥西呱是惟一具有适应证的靶向药物。然而,慢性血栓栓塞性肺动脉高压与肺动脉高压（PAH）两者临床与病理表现有相似之处,临床上也有应用其他肺动脉高压靶向药物治疗慢性血栓栓塞性肺动脉高压的患者,并且部分药物随机对照试验（RCT）研究也显示其疗效和安全性,为患者提供了新的治疗策略。     

The diagnosis of pulmonary thromboembolism in sickle cell disease

The symptoms of thromboembolism in sickle cell anemia patients with acute chest syndromes are difficult to differentiate from the similar symptoms of painful thoracic crises and infectious pulmonary episodes. Furthermore, the chronic pulmonary abnormalities in sickle cell disease frequently contribute to the confusing results of noninvasive diagnostic procedures usually employed in evaluating pulmonary thromboembolism. In this study the chronic pulmonary status of asymptomatic sickle cell patients was defined, and this information was used in the evaluation of patients with acute chest syndromes suggestive of pulmonary thromembolism. Sixteen asymptomatic sickle cell patients were prospectively studied by chest roentgenography, spirometry, arterial gas analyses, and radioisotopic lung scans. There was an appreciable degree of preexisting chronic restrictive lung disease with mild to moderate arterial hypoxemia and abnormal lung scans in more than half of the patients. These prospective baseline data were incorporated into the diagnostic evaluation of four of these patients who later developed an acute chest syndrome suggestive of pulmonary thromboembolism. Determination of the cause of the chest pain was greatly faciliated by the existence of the baseline pulmonary data. In another patient persistence of abnormal studies following a presumed thromboembolic episode aided diagnostic evaluation when another episode of chest pain occurred. The findings indicate that comprehensive pulmonary studies in sickle cell patients while in an asymptomatic state will provide baseline data which aid the evaluation of possible pulmonary thromboembolism in acute chest syndromes without resorting to high-risk invasive studies.     

The lupus anticoagulant, pulmonary thromboembolism, and fatal pulmonary hypertension.

A patient with a circulating lupus anticoagulant in the absence of systemic lupus erythematosus developed recurrent deep venous thromboses and pulmonary emboli. Pulmonary emboli recurred despite prolonged oral anticoagulant therapy and resulted in fatal pulmonary arterial hypertension. Extended anticoagulant therapy alone may not prevent recurrent thromboembolism in patients with a lupus anticoagulant. Pulmonary thromboembolism may be an important factor in the pathogenesis of pulmonary hypertension in patients with a lupus anticoagulant.     

Paradoxical peripheral embolism coincident with acute pulmonary thromboembolism

Paradoxical embolism may occur in patients with acute pulmonary thromboembolism, when patent foramen ovale (PFO) coexists with pulmonary hypertension (right-left shunt). There have been few case reports of paradoxical embolism in peripheral arteries coincident with acute pulmonary thromboembolism. Here, we describe a case of paradoxical peripheral embolism associated with PFO complicated by acute pulmonary thromboembolism. The patient had severe peripheral ischemia due to a massive thrombus and was treated successfully by peripheral thrombectomy, thrombolysis, implantation of a permanent inferior vena cava filter and anticoagulation.     

Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism in three patients with systemic lupus erythematosus and antiphospholipid syndrome]

Pulmonary hypertension (PH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Several potential mechanisms have been postulated for narrowing of vessels as a result of pulmonary vasculitis and pulmonary thromboembolism caused by antiphospholipid antibodies. Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism is performed to alleviate pulmonary hypertension. We report three rare cases of SLE with antiphospholipid syndrome in patients who presented with PH secondary to chronic pulmonary thromboembolism. Pulmonary thromboendarterectomy was performed, and all patients remained well without deterioration of PH after surgery. Pulmonary thromboendarterectomy should be considered as an effective method of treatment for this disease.     

Primary pulmonary artery sarcoma mimicking pulmonary thromboembolism

A 69-year-old woman presenting with dyspnea had a pericardial window created for fibrinous pericarditis. The patient subsequently developed pulmonary hypertension and a ventilation perfusion scan was compatible with pulmonary thromboembolism. A primary tumour of the pulmonary artery was suggested by angiography, computerized axial tomography and magnetic resonance imaging. Pathology confirmed a spindle cell pulmonary artery sarcoma.     

Pulmonary hypertension from chronic pulmonary thromboembolism

Pulmonary hypertension may develop whenever chronic obstruction of pulmonary arterial blood flow occurs. Although repeated pulmonary embolism is thought to be the usual underlying cause, there is little clinical evidence to support this theory. Studies of the pulmonary vascular endothelium have shown that perturbations of the normal endothelium can create a procoagulant environment, which could lead to the development of thrombosis in situ at the level of the large or smaller pulmonary vessels. Some patients develop proximal pulmonary thromboemboli, which may be the result of retrograde propagation of thrombus after an initial pulmonary embolus. Others present with unexplained pulmonary hypertension secondary to thrombotic occlusion of the pulmonary microvasculature. A perfusion lung scan will show abnormalities that should lead to correct clinical diagnosis and confirmatory evaluation. Thromboendarterectomy in selected cases provides dramatic clinical improvement in patients with proximal thromboemboli. Vasodilators may be effective in some patients with obstruction at the arteriolar level. Both groups should be treated with chronic warfarin anticoagulant therapy to protect against progression of thromboembolism.     

Fever and pulmonary thromboembolism.

Fever patterns associated with pulmonary thromboembolism have not been well characterized. Upon review of 35 consecutive patients with angiographically documented pulmonary emboli, fever was present in 24 patients; and in 20, it was attributed solely to pulmonary thromboembolism. Analysis of these cases indicates that high fever (temperature greater than 39 degrees C) due to pulmonary thromboembolism may occur early, and low-grade fever may continue for a week or more. Fever persisting beyond six days, however, especially with temperatures over 38.5 degrees C, should not be ascribed to pulmonary thromboembolism unless other causes have been carefully excluded. If the clinical setting and patient's findings are consistent with pulmonary thromboembolism, one should not be deterred from presumptively making this diagnosis and initiating therapy because of the presence of high fever.     

肺血栓栓塞症的诊断研究进展

近年来,肺血栓栓塞症的诊断研究进展主要包括以下几个方面:①就多种临床症状评分对肺血栓栓塞症的诊断价值进行了大量研究;②通过前瞻性大规模临床试验对肺通气/灌注扫描、螺旋CT肺动脉造影/螺旋CT静脉造影等检查手段的诊断价值进行了评价,③制定了一些肺血栓栓塞症诊断流程.     

36例肺血栓栓塞症临床分析

目的 探讨肺血栓栓塞症的临床特点、诊断方法、治疗措施和治疗效果.方法 对2005～ 2010年我院收治的36例PTE患者进行临床分析.结果 肺血栓栓塞症的患者中以呼吸困难最为常见,32例(89％).34例经CT肺动脉造影明确诊断,积极溶栓及抗凝治疗后症状改善.结论 CT肺动脉造影可帮助肺血栓栓塞症诊断,及时规范的溶栓及抗凝治疗效果肯定.     

Study of the echocardiographic diagnosis of acute pulmonary thromboembolism and risk factors for venous thromboembolism

OBJECTIVES: To identify the relationship of risk factors for atherosclerosis with venous thromboembolism (VTE) and the utility of transthoracic echocardiography in acute pulmonary thromboembolism (APTE). METHODS: In 75 patients with VTE (VTE group), 101 patients with suspected VTE (N group), and 50 control subjects (control group), the frequency of atherosclerosis risk factors such as hyperlipidemia, obesity, hypertension, smoking, and diabetes mellitus and the number of risk factors were evaluated. Transthoracic echocardiographic findings such as tricuspid regurgitation, right ventricular dilation, pulmonary hypertension, and right ventricular dysfunction were evaluated in 15 patients with APTE (APTE group) and 38 patients in the N group (NC group). RESULTS: The incidence of hyperlipidemia in the VTE group was statistically higher than that in the control group (odds ratio 2.16, 95% confidence interval 1.43-3.08). Additionally, the incidence of obesity was higher in the VTE and N groups than in the control group (odds ratio was 2.76, 95% confidence interval 1.67-4.37). Risk factors other than obesity and hyperlipidemia and the number of risk factors were not significant. The incidence of tricuspid regurgitation, right ventricular dilation, and pulmonary hypertension in APTE was statistically greater than that in NC group. Right ventricular dilation and right ventricular dilation + tricuspid regurgitation are reliable findings in echocardiography. However, even combining with tricuspid regurgitation, right ventricular dilation is insufficient to identify or screen patients with APTE. CONCLUSIONS: Hyperlipidemia and obesity may be risk factors for VTE. However, obese patients can manifest similar findings to VTE. Although transthoracic echocardiograpghy is not recommended as a diagnostic or screening test in APTE, it should be used as an ancillary test.