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.     

急性肺血栓栓塞症患者心电图动态浅析

目的探讨急性肺血栓栓塞症患者发病前后心电图动脉变化情况,以进一步提升心电图在急性肺血栓栓塞症中的诊断价值。方法选取我院2012年3月~2016年3月收治的急性肺血栓栓塞症患者52例为研究对象,所有患者均经胸部X线、螺旋CT和肺动脉造影确诊,对患者发病前后心电图动态变化情况进行对比分析。结果 52例急性肺血栓栓塞症患者中,出现心电图动态变化患者49例(94.23%)。窦性心动过速、房性心律失常、S1QmTm、QmTm、Tv1-v3发生情况与治疗前相比,差异有统计学意义(P0.05)。结论急性肺血栓栓塞症患者的心电图动态变化情况多样复杂,通过对比患者治疗前后的心电图动态变化情况,并结合临床症状,可提高临床诊断准确率,值得推广。     

320排螺旋CT肺动脉造影与核素肺通气灌注扫描评价肺动脉栓塞的对照研究

目的探讨以核素肺通气灌注扫描为参照,评价320排螺旋CT肺动脉造影诊断肺动脉栓塞的临床价值。方法 23例可疑PE患者为研究对象,分别采用核素肺通气灌注扫描和320排螺旋CT肺动脉造影进行检测,并以核素肺通气灌注扫描为诊断标准,评估320排螺旋CT肺动脉造诊断肺动脉栓塞临床价值。结果 23例患者460个有效肺段中核素肺通气灌注扫描显示128个肺段出现V/Q失衡,320排螺旋CT肺动脉造影显示124个肺段动脉血管充盈缺损。以NLVPS为参考,320排螺旋CT肺动脉造影诊断肺动脉栓塞的敏感性为0.95(95%CI:0.89-0.98),特异性为0.96(95%CI:0.94-0.98),阳性似然比为26.33(95%CI:14.71-47.12),阴性似然比为0.06(95%CI:0.03-0.11),诊断优势比为475.06(95%CI:179.99-1253.91)和受试者工作特征曲线下面积为0.98。结论 320排螺旋CT肺动脉造影可作为肺动脉栓塞的无创快速诊断方法。     

肺血栓栓塞症18例临床分析

目的:探讨肺血栓栓塞症危险因素与发病的关系,提高对肺血栓栓塞症的诊断及治疗水平。方法:对1993年元月～2002年12月确诊的18例肺血栓栓塞患者的易患因素、临床表现、辅助检查、治疗方法进行临床回顾分析。结果:肺血栓栓塞症的临床表现差异较大,容易误诊,本组误诊率达52.9%,本组有11例死亡,病死率61.1%,6例患者经手术、溶栓及抗凝治疗后存活,1例自动出院。深静脉血栓形成是本组肺血栓栓塞症发生的主要原因。结论:肺血栓栓塞症的发病率与易患因素密切相关,综合医院临床医师应提高对肺血栓栓塞的警惕性,仔细查找病因,常规X线、动脉血气分析、心电图、血管超声等均有助于其诊断,但肺灌注显像及螺旋CT更方便可靠。     

多层螺旋CT肺血管造影在肺动脉栓塞中的诊断价值

目的 研究多层螺旋CT肺血管造影在肺动脉栓塞诊断中的诊断价值.方法 对18例经16层螺旋CT确诊的肺栓塞患者进行回顾性分析.结果 18例患者共累及224支肺动脉及其分支,其中肺动脉干1支,左、右肺动脉共9支,叶动脉45支,段动脉78支,亚段动脉及以下动脉分支91支.肺栓塞的CT表现:①直接征象:中心型充盈缺损、偏心型充盈缺损、附壁血栓、完全阻塞型充盈缺损.②间接征象:肺野透过度增高,肺纹理稀疏、细小,肺动脉高压,肺梗死,主、肺动脉增宽,右心室增大,心包积液、胸腔积液等.结论 多层螺旋CT肺血管造影是诊断肺动脉栓塞的一种快捷、无创、安全、可靠的影像诊断方法,对及时诊断和治疗肺动脉栓塞有重要的临床意义.     

螺旋CT在肺动脉高压疾病中的应用

目的 探讨螺旋CT在肺动脉高压疾病中的应用价值。方法 回顾分析了31例肺动脉高压的临床和螺旋CT资料，其中慢性血栓栓塞性肺动脉高压18例，原发性肺动脉高压2例，结缔组织病4例，肝肺综合征2例，纵隔纤维化1例，Takayasu动脉炎1例，房间隔缺损2例，肺淋巴管肌瘤病1例。CT普通扫描结合CT肺动脉造影观察肺窗和纵隔窗以分别显示肺实质、肺血管、肺门及纵隔结构。结果 CT肺动脉造影诊断了96．77％待查肺动脉高压，同时对肺动脉高压原因做了有益的分析。结论 CT普通扫描结合CT肺动脉造影能准确诊断肺动脉高压，为明确病因或倾向性病因诊断提供有用信息。     

16层螺旋CT动脉造影在肺动脉栓塞诊断中的应用

目的探讨16层螺旋CT动脉造影(computed tomography pulmonary angiography,CTPA)对肺动脉血栓栓塞(pulmonary thromboem bolism,PTE)的诊断及临床应用价值。方法回顾性分析2007年1月—2009年7月经临床诊断的30例肺动脉栓塞患者的CT征象。结果 30例累及150处肺动脉。栓子形态包括完全充盈缺损30支,中心充盈缺损16支,偏心性部分充盈缺损51支,附壁充盈缺损53支。其中发现6例主干并其分支联合栓塞,笔者认为分支栓塞为继发血栓形成。结论螺旋CTPA检查具有快捷、无创、经济、安全、敏感性高、特异性强等特点,是诊断肺动脉血栓栓塞症的首选检查。     

多层螺旋CT对肺动脉栓塞和深静脉血栓诊断的临床观察

目的观察多层螺旋CT对肺动脉栓塞和深静脉血栓的临床诊断价值。方法选择32例肺动脉栓塞患者(包括12例深静脉血栓患者)作为研究对象,分别给予4层螺旋CT和16层螺旋CT进行检查,观察对比不同扫描条件和后处理技术对于周围动脉、栓子、深静脉血栓的CT影像学结果。结果延迟90 s时,4层螺旋CT和16层螺旋CT的影像学结果差异显著(P0.05);延迟120 s、180 s、240 s时,4层螺旋CT和16层螺旋CT的影像学结果差异不显著(P0.05)。结论多层螺旋CT对肺动脉栓塞和深静脉血栓诊断的临床效果令人满意,其中,16层螺旋CT的最佳延迟扫描时间为120 s和180 s,在临床诊断肺动脉栓塞和深静脉血栓方面具有重要参考意义。     

CT诊断肺血栓栓塞症-深静脉血栓形成的临床应用进展

临床实践证明CT诊断肺血栓栓塞症 (PTE)和深静脉血栓形成 (DVT)的敏感性及特异性较高 ,本文综述了CT肺动脉造影 (CTPA)和间接性CT静脉造影 (CTV)的临床应用、比较影像学及发展前景。CTPA CTV可作为诊断PTE DVT的首选检查方法。CT肺血流灌注技术 ,可以在微血管水平定量研究肺血流灌注 ,评价肺血流灌注功能 ,用于指导治疗、评价疗效     

肺血栓栓塞症74例诊治分析

目的通过总结肺血栓栓塞症（PTE）患者的临床特征、辅助检查、治疗等,加强对本病的认识和了解。方法收集74例肺血栓栓塞症患者的临床资料,分析其临床表现、实验室检查、治疗与转归的特点。结果74例肺血栓栓塞患者临床表现依次为呼吸困难、胸痛、咯血、咳嗽、低血压、烦躁、濒死感、发热、胸闷、心悸、晕厥。其中表现为典型肺梗死三联征者19例（25．7％）。血气分析PaO2下降67例（90．5％）,血D-二聚体〉500μg／L者55例（74．3％）,心电图异常者67例（90．5％）,CT肺动脉造影阳性者65例（87．8％）,超声心动图提示肺动脉高压51例（68．9％）,下肢血管超声检查提示下肢深静脉血栓49例（66．2％）。平均确诊时间为（3．8±1．7）天,误诊率为33．8％。单纯抗凝治疗58例,有效率为100％;溶栓16例,治愈率为75．0％,死亡率为25．0％。结论肺血栓栓塞症患者临床表现各异,无特异性诊断方法,CT肺动脉造影对肺血栓栓塞症有重要诊断价值,早期诊断,积极抗凝治疗效果好,溶栓治疗应严格掌握适应证。     

The role of ethnicity,age and gender in venous thromboembolism

Venous thromboembolism, including both deep venous thrombosis and pulmonary embolism, is the leading cause of preventable in-hospital mortality. In the inexorable progress towards individualization of risk and personalized medicine, several congenital and acquired risk factors have been identified. However, the influence of some demographical variables, especially ethnicity, age and gender, has largely been under appreciated. Although the incidence of venous thromboembolism varies widely among diverse racial/ethnic cohorts, it appears globally highest in Blacks, is intermediate in Caucasians and is lowest in Asians. The incidence and prevalence of venous thromboembolism is also strongly age-related, increasing nearly 90 fold from <15 to >80 years old. Definitive data on the relative frequency of venous thromboembolism across genders is lacking. Some studies report that gender is not an independent risk factor of venous thromboembolism, while others conclude that female gender might be a protective variable. The purpose of this review is to assess the relationship between such demographic variables and venous thromboembolism.     

Venous thromboembolic disease

During the past year, the findings of several clinical trials have been published that have important implications for the care of patients with venous thromboembolism. These clinical trials have produced advances in the diagnosis and treatment of venous thrombosis and pulmonary embolism and in the prevention of venous thromboembolism in high-risk patients. In patients with clinically suspected pulmonary embolism, the value and limitations of ventilation-perfusion lung scanning have been established, and it is now accepted that objective tests for deep vein thrombosis have an important role. There have been important advances also in the diagnosis of deep vein thrombosis; these advances include the finding that impedance plethysmography is effective in pregnant symptomatic patients and the development of an objective technique for Doppler ultrasound. The optimal duration of initial intravenous heparin treatment of established thrombosis has been determined. In the prevention of venous thromboembolism, the effectiveness of sequential intermittent compression in patients having hip replacement has been established, and further data on the effectiveness of low-molecular-weight heparin in high-risk patients have become available.     

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.     

Low-molecular-weight heparin for the treatment of venous thromboembolism in the elderly.

Venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) is a common problem in the elderly population. Indeed, increasing age is a significant risk factor for venous thromboembolism. The treatment of venous thromboembolism in the elderly population presents certain unique problems related to aging, such as decreasing body weight, increasing renal insufficiency and numerous comorbid conditions, which complicate therapy. Treatment of venous thromboembolism in the elderly has been complicated by an increased incidence of bleeding, particularly with the use of warfarin. The risk of bleeding may be substantially reduced by carefully adjusting the warfarin dose to maintain a therapeutic INR and for this purpose anticoagulant management clinics have been shown to be useful. The low-molecular-weight heparins have been shown to be efficacious and safe for the treatment of venous thromboembolism in several clinical trials, including many patients in the older age brackets. Furthermore, these agents can safely be used in the out-of-hospital setting. Long-term use of low-molecular-weight heparin is an alternative to the use of oral anticoagulant therapy, particularly in patients with cancer or recurrent venous thromboembolism.     

An overview of methods for detection of factor V Leiden and the prothrombin G20210A mutations

Venous thromboembolism, represented by deep venous thrombosis and pulmonary embolism, is a common disease with high mortality and morbidity. Within the last 25 years, risk factors for venous thromboembolism have been linked to mutations in the genes of the coagulation/anticoagulation system. Factor V Leiden and the prothrombin G20210A mutations are the most prevalent inherited risk factors predisposing to venous thromboembolism in the Western world. Tests to detect these mutations are carried out when investigating a personal or family history of venous thromboembolism. At the present, there are several different methods available for the detection of these mutations in the laboratory. The choice of the method will depend on many variables. This article is aimed at reviewing the available methods for the detection of factor V Leiden and prothrombin G20210A mutations, their principle, applicability, advantages and disadvantages of use.     

Risk factors for pulmonary complications, including pulmonary embolism, after total knee arthroplasty (TKA) in elderly Koreans

There has been a steady increase in elective TKA in elderly Koreans. However, there are few reports about the incidence of and risk factors for pulmonary complications, including pulmonary thromboembolism in these patients. We evaluated retrospectively 338 patients aged 60 years and over (290 females, median age 69 years) to assess the incidence and predictive factors for pulmonary complications, including pulmonary thromboembolism after TKA. Of these patients, 264 underwent simultaneous bilateral TKA (78%) by two surgeons and 56 (17%) had general anesthesia. No patient received thromboprophylaxis. There were 49 postoperative pulmonary complications in the 338 patients (14.2%, 49/338). Of the 49 patients, 27 developed atelectasis (27/49), six developed pneumonia (6/49), and four had pleural effusions (4/49) within 7 days of the surgery; 12 patients had a pulmonary thromboembolism (12/49) during their hospitalization. No pulmonary complication was fatal. Multivariate analysis revealed that pulmonary hypertension (right ventricular systolic pressure ≥ 35 mmHg on transthoracic echocardiography; odds ratio (OR) = 3.0, p = 0.016) was independently associated with pulmonary complications. A resting PaCO₂ ≥ 45 mmHg (OR = 22.9, p = 0.004) was the only independent predictor of the development of a pulmonary thromboembolism. Pulmonary hypertension may thus predict pulmonary complications and a PaCO₂ greater than 45 mmHg may be a risk factor for pulmonary thromboembolism following TKA. Preoperative blood gas analysis and transthoracic echocardiography can identify those patients at high risk for pulmonary complications, including pulmonary thromboembolism, after TKA in elderly Korean patients.     

Protein C deficiency in a family with thromboembolism and identified gene mutations

Protein C is the central component of the major anti-thrombotic regulatory system, and individuals with hereditary protein C deficiency tend to have an increased risk of thromboembolism. During the last several years, mutations causing protein C deficiency have been identified. In the present study, we report familial cases with three nucleotide substitutions: One is a missense mutation Arg169Trp, which was previously reported. The other two are C-154T promoter polymorphism (rs1799808 on dbSNP database), the function of which is unknown and Ser99Ser synonymous polymorphism (rs5936). All three mutations were found in a 24-year-old patient with pulmonary thromboembolism and his 54-year-old father who also had pulmonary thromboembolism. C-154T promoter polymorphism (rs1799808 on dbSNP database) and Ser99Ser synonymous polymorphism (rs5936) were found in the patient's mother.     

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.     

ACE基因插入/缺失多态与国人肺血栓栓塞症的关联研究

目的探讨血管紧张素转换酶(ACE)基因插入/缺失(ID)多态是否与肺血栓栓塞症存在关联,D等位基因是否增加国人肺血栓栓塞的危险。方法放射性核素肺通气-灌注扫描和(或)超高速CT检查并结合临床资料确诊的肺血栓栓塞症患者72例及性别、年龄匹配的健康对照者72名。调查静脉血栓形成和肺栓塞相关危险因素。酚-氯仿法提取基因组DNA,聚合酶链反应(PCR)鉴定ACE基因I/D多态点基因型。结果(1)病例组外伤、手术史及下肢静脉炎、静脉曲张发生率显著高于对照组,肺血栓栓塞家族史、心血管疾病家族史、口服避孕药、吸烟及饮酒史两组间差异无显著性。(2)健康对照组I、D等位基因频率分别为66％和34％,基因型分布符合Hardy-Weinberg平衡。Ⅱ、ID和DD基因型及I、D等位基因频率在病例和对照组差异无显著性。(3)进一步分别按显性、隐性和加性作用方式探讨ACE基因I/D多态与肺血栓栓塞症的关系,发现DD基因型个体肺栓塞危险显著增加(OR=2.51,P＜0.05),提示D等位基因为隐性作用方式。(4)将肺血栓栓塞患者按有无明确静脉血栓形成及肺栓塞环境诱因分组,结果显示无明确环境诱因组DD基因型频率显著高于对照组(27.1％vs14.3％;OR=2.64,P＜0.05),而有明确环境诱因组与对照组相比DD基因型频率差异无显著性。将肺血栓栓塞患者按是否合并下肢静脉血栓形成分组,结果显示肺栓塞合并下肢静脉血栓形成组DD基因型频率显著高于健康对照组(32.4％vs14.3％;OR=3.36,P＜0.05),单纯肺栓塞组与健康对照组比较差异无显著性。结论ACE基因I/D多态与国人肺血栓栓塞有关,D等位基因为隐性作用方式。DD基因型显著增加无明确静脉血栓形成及肺栓塞环境诱因个体肺栓塞危险;有下肢静脉血栓形成病史的DD基因型个体肺栓塞危险亦显著增加。     

IL-13、TGF-β在急性肺血栓栓塞兔模型中的表达

目的 通过研究IL-13、转化生长因子β(TGF-β)在急性肺血栓栓塞兔模型中的表达,探讨Th2型免疫反应在急性肺栓塞发病机制中的作用.方法 选取大耳白兔36只,分为模型组及对照组,每组18只.采用自体血栓回输法建立肺血栓栓塞模型.分别于栓塞后第2、4、14天采集模型组及对照组血清,应用酶联免疫吸附试验方法检测IL-13、TGF-β含量.结果 模型成功率为90%.模型组血清中IL-13、TGF-β水平分别于栓塞后第4、14天升高,分别为(36.86±3.06)ng/L、(1591.67±55.02)ng/L,显著高于对照组(P值均<0.05).结论 肺栓塞进程中IL-13与TGF-β水平升高.