急性脑卒中患者静脉血栓栓塞症调查及危险因素探讨

<正>静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓形成(deep venous thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE)。脑卒中患者是VTE发生的高危人群,如果不给予任何干预措施,30%~40%的脑卒中患者会发生DVT,严重     

老年人静脉血栓栓塞症的流行病学

<正>静脉血栓栓塞症(venous thromboembolism,VTE)包括肺血栓栓塞症(pulmonary thromboembolism,PTE)和深静脉血栓形成(deep venous thrombosis,DVT)2大类,是同一种疾病在不同部位的2种表现形式。随着病理生理研究的深入和诊断策略的改进,以往对于VTE尤其是PTE"少发病、罕见病"的认识得到了根本的转变,VTE的发病率     

肺血栓栓塞症—深静脉血栓形成的分子流行病学

肺血栓栓塞症(pulmonary thromboembolism，PTE)与深静脉血栓形成(deep venous thrombosis，DVT)共属于静脉血栓栓塞症(venous thromboembolism，VTE)。已公认VTE是一种多基因疾病，抗凝、凝血、纤溶系统以及某些酶类相关基因的异常均可成为其遗传性危险因素(表1)。     

蛋白C路径基因多态性与静脉血栓栓塞症相关性的研究进展

静脉血栓栓塞症(venous thromboembolism,VTE)主要包括深静脉血栓形成(deep venous thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE),是一种遗传因素与环境因素共同参与的高发病率、高病死率、高致残率及高复发率的疾病[1-3],故不断探索和明确其危险因素,对于早期识别高危患者和开展疾病预防具有重要意义.     

D-二聚体检测在静脉血栓栓塞症诊断中应用的新进展

<正>静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓形成(deep vein thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE),二者是同一疾病的不同表现形式。VTE在临床上并不少见。欧美国家的统计显示,VTE已经成为第三位的心血管疾病[1]。在我国,根据中国静脉血栓栓塞防治协作组(NCPPT)对1997~2008年的肺栓塞患者进行的流行病学调查,PTE患者占住院总人数的0.1%[2]。不仅如此,VTE还具有较高致残率及致死率。据     

精神药物的暴露与静脉血栓栓塞症发生风险的研究进展

<正>静脉血栓栓塞症(venous thromboembolism, VTE)包括肺血栓栓塞症(pulmonary thromboembolism, PTE)与深静脉血栓形成(deep venous thrombosis, DVT),是一种常见的疾病，具有显著的发病率和死亡率。越来越多的研究表明VTE与精神药物的使用之间存在联系。一项关于精神病院中VTE发生率的研究显示：精神病院环境中VTE的发病率很高，尤其是在患者入院的最初几天，     

重视肺血栓栓塞症合并冠心病的诊断和治疗

近年来，我国肺血栓栓塞症（pulmonary thromboembolism，PTE）报道的病例数明显增加，由原来认为的少见病，已成为常见病和多发病。引起PTE的血栓主要来源于深静脉血栓形成（deep venousthrombosis，DVT），PTE常为DVT的并发症。PTE与DVT共属于静脉血栓栓塞症（venous thromboembolism，VTE）。     

P选择素在静脉血栓栓塞症发病机制中的作用及与炎症的关系

静脉血栓栓塞症(venous thromboembolism,VTE)主要包括深静脉血栓形成(deep venous thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE),是同一疾病病程中两个不同阶段的不同临床表现.欧洲的研究资料表明,症状性VTE发生人数每年超过150万,VTE相关死亡人数每年约54.35万.我国VTE的诊断也呈逐年上升趋势.已有多项研究表明P选择素作为炎症因子,在VTE发病机制中起了重要作用,而炎症本身又与VTE有着密切的联系.我们即以VTE发病机制出发,总结P选择素在VTE中的作用及与炎症的关系.     

无诱因静脉血栓栓塞症与恶性肿瘤的相关性研究进展

<正>静脉血栓栓塞症(venous thromboembolism,VTE)是深静脉血栓形成(deep vein thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE)的合称,多种危险因素均可导致VTE的发生。恶性肿瘤是VTE的持续危险因素之一,可以增加VTE的发生风险。相反,VTE也可能是恶性肿瘤的首发症状,VTE患者的恶性肿瘤发生率是正常人群的6倍^[1-2]。     

静脉血栓栓塞症复发相关危险因素研究进展

肺血栓栓塞症(pulmonary thromboembolism,PTE)是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主要临床和病理生理特征.PTE是一种高发病率、高病死率、高致残率的疾病,近年来随着临床医生对PTE认识的加深和重视程度的增加,本病诊断率逐年提高.PTE的血栓主要来源于深静脉血栓形成(deep venous thrombosis,DVT),常见于下肢静脉及盆腔静脉.DVT 与PTE实质上是同一种疾病过程在不同部位、不同阶段的表现,合称为静脉血栓栓塞症(venous thromboembolism,VTE).     

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…     

Chronic pulmonary embolism and pulmonary hypertension

Incomplete resolution of acute pulmonary embolism (PE) is frequently observed after acute PE and may rarely result in chronic thromboembolic pulmonary hypertension (CTEPH). The underlying pathophysiological mechanism is largely unknown. Evidence underlines the concept of a dual pulmonary vascular compartment model consisting of increased pulmonary vascular resistance by both large vessel obstruction and distal small vessel obliteration, the latter initiated by pathological vascular remodeling. Up to 40% of patients with established CTEPH have no prior history of symptomatic venous thromboembolism. CTEPH is associated with a poor prognosis if left untreated. Therefore, the diagnostic approach of CTEPH aims at assessing the location and extent of the embolic obstruction, establishing the operability and prognosis of the patients and ruling out other variations of pulmonary hypertension with distinct indicated treatment. Heart catheterization for invasive pressure measurements and pulmonary catheter angiography is obligatory for the final diagnosis. Pulmonary thromboendarterectomy is the treatment of choice. In certain patients with persistent or recurrent pulmonary hypertension after surgery or with inoperable disease, pharmacotherapy might be beneficial.     

Retrograde pulmonary perfusion improves results in pulmonary embolectomy for massive pulmonary embolism

Mortality rates for pulmonary embolectomy in patients with acute massive pulmonary embolism have decreased in recent years. However, they still range from 30% to 45% when the surgery is performed on critically ill patients, and the rates reach 60% in patients who have experienced cardiac arrest before the procedure. The causes of death in these patients are generally attributed to right heart failure due to persistent pulmonary hypertension, intractable pulmonary edema, and massive parenchymal and intrabronchial hemorrhage. Clinical and experimental findings indicate that venous air embolism causes severe or even lethal damage to the pulmonary microvasculature and the lung parenchyma consequent to the release of endothelium-derived cytokines. These findings are similar to those observed when severely compromised patients undergo pulmonary embolectomy-air entrapped in the pulmonary artery during embolectomy can lead to fatal outcomes.Besides enabling the removal of residual thrombotic material from the peripheral branches of the pulmonary artery, retrograde pulmonary perfusion fills the pulmonary artery with blood and prevents pulmonary air embolism. In this retrospective study, we analyzed a series of 21 consecutive critically ill patients in whom we applied retrograde pulmonary perfusion while performing standard pulmonary embolectomy. No patient died or experienced major postoperative complications. We believe that the use of retrograde pulmonary perfusion decreases morbidity and mortality rates associated with pulmonary embolectomy in critically ill patients.     

Residual pulmonary thromboemboli after acute pulmonary embolism

BackgroundAfter an acute pulmonary embolism (PE), the complete resolution of thromboemboli may not be routinely achieved. The rate of persistence may depend on the time and the diagnostic technique used for evaluation.Patients and methodsPatients were diagnosed with acute PE by means of computed tomography angiography (CTA). While they were receiving anticoagulant therapy, a second CTA was used to explore the rate of persistence of residual thromboemboli. During the initial episode, the plasma levels of Troponin I and natriuretic peptide, patient demographics, and hemodynamic and gas exchange data were evaluated as risk factors for persistence of pulmonary thromboemboli.ResultsIn this study 166 patients were diagnosed. A second CTA was not made in 46 (28%) patients for different reasons. In 120 (72%) patients a second CTA was made 4.5 [SD2.34] months after the initial episode (range 2–12 months). Complete clearance of thrombi occurred in 89 (74%, 95% CI 65–81) patients. Residual thrombi remained in 31 (26%, 95% CI 18–34) patients. In 6%, 13% and 81% of the patients the size of the residual thrombi was greater, similar to and smaller than initially diagnosed, respectively.The risk factors for residual thrombi included the thrombotic burden (OR 1.95), the alveolar to arterial difference of oxygen (OR 1.64), and the clinical antecedents of venous thromboembolic disease (OR 0.65).ConclusionsAfter 4.5 months of anticoagulant therapy, residual pulmonary thromboemboli persisted in 26% of the patients. The risk factors for residual thromboemboli include a greater initial thrombotic burden, a deeper gas exchange disturbation and a history of previous venous thromboembolism.     

Acute pulmonary embolism and pulmonary infarction]

32 cases of pulmonary embolism were reported, 18 cases had been autopsied (massive pulmonary embolism 9 cases. moderate pulmonary embolism 23 cases). The incidence risk factors pathogenesis, clinical manifestations of pulmonary embolism were presented. The relation between pulmonary embolism and pulmonary infarction and treatment of massive pulmonary infarction were discussed.     

Balloon-occlusion pulmonary cineangiography for diagnosing pulmonary embolism

For the angiographic diagnosis of pulmonary embolism (PE) we performed balloon-occlusion pulmonary cineangiography in ten consecutive patients. The technical aspects of the balloon-occlusion cineangiographic technique are reviewed, and its complementary role in the diagnosis of PE are outlined and illustrated with several examples.     

Ruptured pulmonary artery aneurysm mimicking pulmonary embolism

Aneurysms of the pulmonary artery are very rare pathological vascular conditions. Peripheral pulmonary aneurysms have been reported only in a few cases. The causes of these aneurysms include extensive degenerative changes, traumas, infection and congenital malformations. Because of the imminent danger of rupture, surgical treatment should always be preferred. The following case report demonstrates one of a multitude of possible misdiagnoses for rupture of a pulmonary aneurysm.