肺动脉栓塞合并矛盾性栓塞的诊断与治疗

目的:评价肺动脉栓塞(PE)合并矛盾性栓塞(PDE)的诊断与治疗效果,探讨PE合并PDE的诊断与鉴别诊断方法。方法:回顾性分析1999年2月至2007年1月我院6例PE合并PDE的临床资料。对急性期合并脑PDE采用脱水治疗、加用或不加用溶栓抗凝治疗;对合并脑以外PDE急诊采用选择性溶栓、抗凝或拉栓治疗。对卵圆孔未闭(PFO)或房间隔缺损(ASD)采用手术或介入伞堵封闭。结果:1例行肺动脉血栓内膜剥脱术及PFO缝闭术,3例行PFO介入封堵,1例行ASD介入封堵,1例PFO未治疗。4例PE经手术或溶栓治愈,2例长期抗凝治疗缓解。随访3个月至7年,1例PFO未治疗的患者于2年后再发脑PDE,另5例未再发PDE,随访检查PFO或ASD封堵器无移位,无右向左分流。心功能Ⅰ级4例,Ⅱ级1例,Ⅲ级1例。结论:1.急性期对脑以外PDE应行急诊溶栓、抗凝或拉栓治疗;对脑PDE应行脱水加用或不加用溶栓抗凝治疗。2.手术或介入治疗闭合心内外右向左分流是根治PDE的必要条件。

The diagnosis and treatment of paradoxical embolism originated from pulmonary embolism

Objective：To evaluate the treatment efficacy of paradoxical embolism （PDE） originated from pulmonary embolism （ PE）, and to explorer the diagnosis and differential diagnosis characteristics of PDE. Method： Retrospectively review the data of 6 PDE originated from PE treated in Anzhen Hospital between February 1999 and January 2007, all of which were treated through different thrombolysis and anticoagulant regimen according the target organ of PDE, and the PFO or ASD were closed surgically or interventional in 5. Result： All of the PDE recovered from the acute phase. Three PFO and one ASD were closed interventional through Amplatzer devices, and one PFO was closed during pulmonary thromboendarterectomy procedure, and one PFO was left unattended. There were no recurrence in the 5 cases of PDE whose interatrial shunts were closed, but there was a recurrence in the one whose interatrial shunt wasn＇t closed. Conclusion-1. If brain is the target organ of the PDE, it is imperative to discriminate if there is bleeding foci after the brain embolism, and to or not to initiate thrombolysis and anticoagulant regimen to treat the PDE. For non-brain target organ of PDE, it was also imperative to initiate thrombolysis and anticoagulant regimen immediately and accordingly. 2. The surgical or interventional closure of the interatrium shunt was the necessary measure to prevent PDE recurrence.