肺血栓栓塞症超声心动图检查操作规程

超声心动图通过二维超声可确切显示右心系统血栓；联合应用二维超声、M型超声及多普勒超声等多种技术对PTE所致的一系列右心负荷改变可进行综合判断。超声心动图检查具有无创、能够床旁检查的优势，在PTE的鉴别诊断中具有重要作用。常规超声心动图因不能显示肺内血管与肺组织灌注情况，在PTE的诊断中有一定的局限性。     

超声心动图右心功能指标在肺血栓栓塞症溶栓前后的变化

目的通过超声心动图检测大面积和次大面积肺血栓栓塞症(PTE)患者溶栓前后的右心功能指标,评价急性期溶栓效果。方法 29例患者(大面积者8例,次大面积者21例),其中男性10例,女性19例;年龄30～75岁,平均年龄59岁(标准差12岁)。均接受溶栓治疗。溶栓前和溶栓后24h观察超声心动图检查指标:左右心室舒张末期前后径(LVED、RVED)、左右心室舒张期横径(LVDD、RVDD)、左右心房舒张期横径(LADD、RADD)、右心室前壁厚度(RVAWT)、右心室前壁运动幅度(RVAWM)、主肺动脉内径(PAD)、三尖瓣反流压差(TRPG)、肺动脉收缩压(SPAP)。计算RVED/LVED、RVDD/LVDD和RADD/LADD比值。结果除RADD外(P=0.041),溶栓前大面积PTE组和次大面积PTE组患者间各指标未见显著性差异。溶栓后大面积者RVAWM、LVED和LADD明显升高(P=0.024,P=0.003,P=0.043);次大面积者LVED明显升高(P=0.001),RVDD、RADD、RADD/LADD比值、TRPG和SPAP明显下降(P=0.003,P=0.016,P=0.006,P<0.001,P<0.001)。结论溶栓治疗可改善PTE患者右心功能不全,超声心动图对PTE的疗效评价有重要意义。     

肺血栓栓塞症临床影像学诊断与介入治疗

肺动脉血栓栓塞（PTE）是临床多发病常见病，病死率高，缺乏特征性临床表现与实验室结果，容易漏诊和误诊，及时正确的诊断和治疗可明显降低死亡率。影像学诊断特别是多层螺旋CT和MR肺动脉成像对PTE的诊断具有重要价值，介入治疗具有特别的作用和疗效。     

肺血栓栓塞症临床影像学诊断与介入治疗

肺动脉血栓栓塞(PTE)是临床多发病常见病,病死率高,缺乏特征性临床表现与实验室结果,容易漏诊和误诊,及时正确的诊断和治疗可明显降低死亡率.影像学诊断特别是多层螺旋CT和MR肺动脉成像对PTE的诊断具有重要价值,介入治疗具有特别的作用和疗效.     

神经外科术后无症状肺血栓栓塞症的诊断及处理

目的 研究神经外科术后的无症状肺血栓栓塞症,提高神经外科术后深静脉血栓及无症状肺血栓栓塞症的诊断及治疗水平。方法 分析我院神经外科诊断并治疗的2例无症状肺血栓栓塞症患者的临床资料,通过D-dimer,超声及CTPA进行筛查及诊断,明确诊断后予以肝素及低分子肝素抗凝治疗,后期行华发林抗凝,其中1例在抗凝治疗前急诊行下腔静脉永久滤网植入术。结果 本组D-dimer筛查结果1例正常,1例稍高于参考值上限;超声证实2例患者均有下肢静脉血栓;CTPA明确诊断为肺血栓栓塞症。抗凝治疗后复查CTPA肺血栓栓塞症有明显改善。2例患者出院后继续华发林抗凝治疗。结论 临床工作中应重视发生肺血栓栓塞症的各种危险因素,及早对高危人群进行筛查,制定围手术期的整体预防和治疗方案。     

肺癌合并肺血栓栓塞症的研究进展

肺癌和肺血栓栓塞症均有高发生率和高致死率的特点,且近年来有上升趋势。肺癌合并肺血栓栓塞症更对患者生命及生存质量产生巨大威胁,其发生机制复杂,临床症状不典型,诊疗存在局限性,预后较差,给患者生活质量和经济造成极大负担,引起越来越多临床医师广泛关注。本文就肺癌合并肺血栓栓塞发生机制、临床特点及诊疗进行回顾性分析及归纳,为早期识别该疾病提供临床依据。     

肺血栓栓塞-深静脉血栓形成影像学检查操作规程（推荐方案） 深静脉血栓形成影像学检查部分——深静脉血栓形成血管超声检查操作规程

在全国肺栓塞-深静脉血栓形成防治协作组和中华医学会呼吸学分会肺血栓与肺血管病学组的统一组织安排下，以国家“十五”科技攻关课题《肺血栓栓塞症的规范化诊断和治疗研究》课题组所采用的技术方案为基础，由国内影像学领域的知名专家制定了肺血栓栓塞症-深静脉血栓形成（PTE—DVT）相关检查的操作规程．     

肺血栓栓塞症肺动脉造影诊断检查操作规程

肺动脉造影（pulmonary arteriography，PA）为PTE诊断的经典参比方法。其敏感性约98％，特异性95～98％。作为一种有创性检查技术，应严格掌握其适应证。     

急性肺动脉血栓栓塞症的诊断及外科治疗

目的探讨急性肺动脉血栓栓塞症的快速诊断、手术治疗和围手术期处理方法。方法 15例急性肺动脉栓塞症患者均在全麻体外循环下行肺动脉血栓切除术。结果术后10 d动脉血氧分压、动脉血氧饱和度均显著高于术前（P〈0.05）;术后10 d心脏超声右室横径、主肺动脉宽度、三尖瓣反流压差和反流面积均明显缩小（P〈0.05）。全组无手术死亡、并发症,术后全部病例心功能完全恢复正常。结论术前及时明确诊断、严格掌握手术适应证和手术时机、手术彻底清除血栓是治疗急性肺动脉血栓栓塞症成功的关键。     

对“肺血栓栓塞症、深静脉血栓形成”的基本概念和“规范影像学检查”的再学习

肺血栓栓塞症（Pulmonary Thromboembolism，PTE）为来自静脉系统或右心的血栓阻塞肺动脉或其分支所致的疾病，以肺循环和呼吸功能障碍为其主要病理生理和临床特征。PTE是肺栓塞（PE）的最常见类型，通常所称的PE即指PTE。急性PTE造成大面积PTE，肺动脉较广泛阻塞时，可引起肺动脉高压，出现急性肺源性心脏病。     

妇科肿瘤围手术期并发下肢深静脉血栓28例诊疗体会

目的探讨妇科肿瘤围手术期并发下肢深静脉血栓的诊断及治疗。方法回顾性分析28例妇科肿瘤围手术期并发下肢深静脉血栓患者的临床资料。结果本组28例患者中恶性肿瘤患者25例，良性肿瘤患者3例，平均年龄51．6岁。经静脉彩色多普勒超声检查并结合D-二聚体监测，确诊后采用全身及局部抗凝、溶栓及活血化淤药物治疗；术前并发中央型、混合型下肢深静脉血栓，及术前或术后并发肺动脉栓塞患者均放置临时性下腔静脉滤器。28例患者均达好转出院，无死亡病例。结论1．妇科肿瘤尤其恶性肿瘤患者围手术期应充分重视LDVT的诊断及治疗。2．下腔静脉滤器可有效预防妇科肿瘤围手术期致命性肺动脉栓塞的发生。     

A survey to establish current methods of venous thromboembolism prophylaxis in stroke patients practiced by Polish neurologists

Introduction

Venous thromboembolism (VTE) is associated with considerable morbidity and mortality in stroke patients. The purpose of our survey was to establish the current methods of VTE prophylaxis practiced by Polish neurologists. We also aimed to determine whether there is enough variation in practice to justify the development of an evidence-based guideline for VTE prevention.

Material and methods

Postal self-administered questionnaires about VTE prophylactic methods practiced by Polish neurologists were sent to 218 neurological wards where stroke is treated. If no response was received, the questionnaire was faxed and finally we attempted to obtain information by telephone.

Results

One hundred and seventy-six (80.7%) stroke centers of 218 responded. The majority (137/176; 77.8%) of centers had a stroke unit. The median admission rate of surveyed wards was estimated to be 320 patients/year (range from 20 to 1000 patients/year). The most common method of VTE prophylaxis reported was low molecular weight heparin (LMWH) (98.9%), and the least common was intermittent pneumatic compression (IPC) (6.8%). Centers admitting ≥ 200 patients/year (70.7% vs. 45%; p = 0.039), and those with stroke units (95 vs. 20; p = 0.031) were more willing to join a randomized trial evaluating any of the methods. All the centers participating in the survey reported a need for a detailed VTE prophylaxis guidelines.

Conclusions

The LMWH is the predominant VTE prophylaxis strategy for stroke patients practiced by Polish neurologists. Due to the variation of methods used in VTE prophylaxis it might be reasonable to further specify this section of stroke treatment guidelines.     

Open Pulmonary Thromboembolectomy in Patients with Major Pulmonary Thromboembolism

Purpose

We retrospectively analyzed open pulmonary thromboembolectomy in patients with acute and chronic pulmonary thromboembolism.

Materials and Methods

Between August 1990 and May 2005, 12 consecutive patients with acute and chronic pulmonary thromboembolism underwent open pulmonary thromboembolectomy at Yonsei Cardiovascular Center. Their mean age was 47.5 years, and 7 of the patients were female. Among 12 patients, 5 had acute onset, and 7 had chronic disease, and 9 patients were associated with deep venous thrombosis. Extent of pulmonary embolism was massive in 3 patients with hemodynamic instability, and submassive in 8 patients. Preoperative echocardiogram revealed elevated right ventricular pressure in all patients, and 7 patients were in NYHA functional class III or IV. Pulmonary thromboembolectomy was performed in all patients under total circulatory arrest.

Results

There were 2 hospital deaths (16.7%). Among the patients who survived, mean right ventricular pressure was decreased significantly from 64.3 mmHg to 34.0 mmHg with improvement of NYHA functional class.

Conclusion

Open pulmonary thromboembolectomy is thought to be an immediate and definitive treatment for massive pulmonary embolism with optimal results. Even though operative mortality is still high, early diagnosis and immediate surgical intervention in highly selective patients may improve the clinical outcome.     

Arrive: A retrospective registry of Indian patients with venous thromboembolism

Background and Aim:

There is lack of substantial Indian data on venous thromboembolism (VTE). The aim of this study was to provide real-world information on patient characteristics, management strategies, clinical outcomes, and temporal trends in VTE.

Subjects and Methods:

Multicentre retrospective registry involving 549 medical records of patients with confirmed diagnosis of VTE (deep vein thrombosis [DVT] confirmed by Doppler ultrasonography; pulmonary embolism [PE] by computed tomography, pulmonary angiography and/or V/Q scan) from 2006 to 2010 at three Indian tertiary care hospitals.

Results:

Acute DVT without PE, acute DVT with PE, and PE alone were reported in 64% (352/549), 23% (124/549), and 13% (73/549) patients, respectively. Mean age was 47 (±16) years, and 70% were males. H/o DVT (34%), surgery including orthopedic surgery (28%), trauma (16%), and immobilization >3 days (14%) were the most common risk factors for VTE. Hypertension (25%), diabetes (19%), and neurological disease (other than stroke) (8%) were the most common co-morbidities. Most (94%) were treated with heparin alone (82%) or fondaparinux (2%) for initial anticoagulation; low molecular weight heparin alone (5%) or warfarin/acenocoumarol (76%) for long-term anticoagulation. Anticoagulant treatment was stopped because of bleeding in 2% (9/515) patients. Mortality was 7% among patients diagnosed with VTE during hospital stay versus 1% in those hospitalized with diagnosed VTE. The annual incidence of DVT (±PE) increased from 2006 to 2010.

Conclusion:

Acute DVT alone was responsible for the substantial burden of VTE in Indian patients. Bleeding was not the limiting factor for anticoagulant treatment in most patients.     

分子成像在静脉血栓栓塞诊断中的研究与应用进展

静脉血栓栓塞(venous thromboembolism,VTE)主要表现为深静脉血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE),由于症状的非特异性,该疾病很难被确诊.此外,治疗DVT的副作用明显,因此正确诊断静脉血栓栓塞具有重要的临床意义.目前临床上用于诊断静脉血栓栓塞的主要手段包括超声、计算机断层扫描和磁共振成像.近年来,随着分子影像学的快速发展,分子成像在静脉血栓栓塞的诊断中将发挥越来越重要的作用.本文对分子成像的靶点、示踪剂及其用于诊断静脉血栓栓塞的研究进展进行综述.     

The Ultrasound Monitoring to the Venous Thromboembolism Associated with Peripherally Inserted Central Catheters in Chemotherapy Patients: A Prospective Cohort Study

Objective

To investigate the incidence of peripherally inserted central catheter–related deep venous thrombosis (PRDVT) and their associated risk factors of PRDVT in the oncological patients who received peripherally inserted central catheters.

D-D和抗凝蛋白检测在下肢深静脉血栓形成患者诊治中的意义

目的 研究下肢深静脉血栓形成（LDVT）的主要发病机制.方法 应用日本Sysmex CA7000型全自动血液凝固仪检测55例LDVT患者（38例初发,17例复发）和60例健康人的血浆D-二聚体（D-dimer,D-D）、抗凝血酶（AT）、蛋白S（PS）,蛋白C（PC）的活性水平.结果 LDVT组与正常对照组相比、LDVT复发组与初发组相比,AT、PS、PC活性明显降低,D-D水平明显升高,均有极显著差异（P〈0.01）.结论 D-D水平升高和先天性或获得性抗凝蛋白缺陷是LDVT发病和复发的重要原因.因此有必要对LDVT患者进行D-D水平和抗凝蛋白水平的筛选.     

下腔静脉滤器预防肺动脉栓塞的应用价值

目的 讨论下腔静脉滤器放置术在下肢静脉血栓形成(DET)患者进行溶栓治疗中预防肺动脉栓塞(PE)的应用价值．方法 37例DET形成患者放置Greenfield下腔静脉滤器22个、Simon滤器12个、Bird—nestle滤器3个，放置后进行下肢静脉溶栓治疗，48h腹平片观察滤器的位置，1周后行彩色多普勒检查了解下腔静脉通畅度，出院后定期复查滤器位置．结果 滤器放置成功率为100％，溶栓过程中及追踪复查均未发生PE．结论 下腔静脉滤器放置术对PE的预防有较高的临床价值，下肢DET成患者行溶栓治疗前，作为常规应用可确保安全．