肺栓塞的诊断进展

肺栓塞诊断较困难,生前确诊率不高,本文就本病近年来有关诊断方面的资料作一综述。     

肺栓塞的早期诊断探讨

目的探讨肺栓塞(PE)的早期诊断。方法对近年来我科收治的20例PE患者的临床资料进行回顾性分析。结果 20例中有呼吸困难者18例(90%),低氧血症16例(80%),低血压12例(60%),心电图呈典型SⅠQⅢTⅢ者4例(20%),血浆D-二聚体500μg/L者20例(100%),螺旋CT检查有典型表现者15例(75%),超声心动图有典型表现者14例(70%),首诊误诊8例(40%),溶栓治疗14例(70%),死亡3例(15%)。结论 PE临床表现缺乏特异性,易误诊。提高对本病的警惕性,对有PE危险因素的患者,一旦出现不明原因的呼吸困难、低氧血症时,合理选择床旁无创检查是提高PE早期诊断率的有效方法 。     

肺栓塞的临床诊断进展

肺栓塞(PE)的危害严重且病死率高,临床表现又缺乏特异性,致使临床上误诊、漏诊较多,但可有效治疗,近年来日益受到人们重视。许多互补的方法用于可疑PE患者的诊断,目前,在可疑PE患者诊断的准确性以及建立更安全可行的临床评估标准方面都取得了很大的进展,寻求更加简便、经济的诊断模式,诊断PE的模式将不断优化。     

老年人肺栓塞的诊断进展

肺栓塞 (ＰＥ)是指肺动脉及其分支被栓子阻塞导致肺实质血供受阻的病理过程。栓子通常为血栓 ,主要来源于下肢静脉或盆腔静脉或右心。气体、脂肪、骨髓、异物、羊水或肿瘤细胞也可栓塞肺血管但较少见。ＰＥ的危害严重、诊断困难 ,但可有效治疗 ,近年来日益受到人们重视。ＰＥ的发病率和死亡率均随年龄的增加而增加 ,但由于老年人常患有基础心肺疾病 ,常存在与ＰＥ类似的临床表现和实验室检查异常 ,致使ＰＥ的诊断困难 ,误诊漏诊率很高。原有心肺疾病的老年人 ,ＰＥ引起的血流动力学变化常更严重 ,抗凝治疗虽可显著减低ＰＥ的死亡危险 ,但治…     

肺栓塞诊断进展

肺栓塞在我国是较常见的临床疾病，但许多患者没有得到正确的诊断，影响了治疗和预后。最近几年，深静脉血栓(DVT)和肺栓塞无论在病因学、流行病学还是在诊断学和治疗学方面，都有较大进展。本文综述了近年来肺栓塞诊断进展，探讨了临床评估、D-二聚体检测、通气／灌注显像、肺血管造影、螺旋CT等对肺栓塞的诊断价值，并对正在研究的放射性核素血栓显像剂进行了综述。     

肺栓塞的诊断现状及进展

肺栓塞的发病率逐年升高,其临床表现缺乏特异性,肺栓塞的误诊和漏诊屡见不鲜.现有多种诊断肺栓塞的方法如心电图、血清学指标、心脏彩超、肺部CT、肺通气/灌注显像等,结合各种方法的优缺点,快速诊断疾病,可大大降低致残率、致死率及病死率.     

肺栓塞患者诊断延迟的危险因素分析

目的：分析肺栓塞（ PE）诊断延迟的危险因素。方法选择PE患者71例,根据其诊断延迟时间分为≤7 d者40例（ A组）、＞7 d者31例（ B组）。收集两组临床资料及D-二聚体、心肌酶、胸部增强CT、超声心动图及下肢彩超检查结果,并进行Wells评分。结果 A、B组有呼吸困难、下肢深静脉血栓（ DVT ）与慢性阻塞性肺疾病（COPD）病史、PO2≤60 mmHg者比较,P均＜0．05;多因素分析显示,呼吸困难是PE诊断延迟的独立危险因素（95％CI为0．080～0．925,P＜0．05）;PE诊断延迟时间与患者年龄无相关性;两组Wells评分比较P＞0．05。结论呼吸困难是PE 诊断延迟的独立危险因素,有DVT、肿瘤病史有助于PE 的早期诊断,有COPD 病史可能使PE 诊断延迟。     

肺栓塞诊断进展

肺栓塞在我国是较常见的临床疾病 ,但许多患者没有得到正确的诊断 ,影响了治疗和预后。最近几年 ,深静脉血栓 (DVT)和肺栓塞无论在病因学、流行病学还是在诊断学和治疗学方面 ,都有较大进展。本文综述了近年来肺栓塞诊断进展 ,探讨了临床评估、D 二聚体检测、通气 /灌注显像、肺血管造影、螺旋CT等对肺栓塞的诊断价值 ,并对正在研究的放射性核素血栓显像剂进行了综述。     

肺栓塞成功抢救一例

病例:患者,女,61岁,因转移性右下腹疼痛2天入院。诊断为急性阑尾炎。在硬膜外麻醉下行阑尾切除术。术后2日出现右小腿发硬、疼痛,初未引起注意。后下地活动后,出现晕厥、大汗、意识不清,大小便失禁。数分钟后意识恢复,觉胸闷气短,查体:血压84mmHg/40mmHg,心率快170次／分,律齐,心音低,无杂音,右下肺呼吸音低,无罗音。急查心     

肺血栓栓塞症的临床诊断进展

肺血栓栓塞症（pulmonary thromboembolism，VIE）为来自静脉系统或右心的血栓阻塞肺动脉或其分支所致疾病，以肺循环和呼吸功能障碍为其主要临床和病理生理特征。VIE为肺栓塞（pulmonary embolism，PE）的最常见类型，占PE中的绝大多数，通常所称PE即VIE。肺动脉发生栓塞后，若其支配区的肺组织因血流受阻或中断而发生坏死，称为肺梗死（pulmonary infarction，PI）。     

Diagnostic methods in pulmonary embolism

Diagnosing pulmonary embolism (PE) is challenging since clinical signs and symptoms are non-specific. The diagnostic tests available for demonstrating PE all have their drawbacks and are often costly and consume considerable amounts of resources. Simple tools that have become available in the last several years include clinical prediction rules and D-dimer testing. Assessment of the clinical probability, combined with a D-dimer test, can limit the need for additional diagnostic tests by 30%. For outpatients with a normal, sensitive ELISA D-dimer test and a low-to-moderate clinical probability, PE can safely be ruled out. Pulmonary angiography, though still the gold standard, is rarely used nowadays because of its invasiveness, its high costs and limited availability, and the declining experience of radiologists with the technique. Two imaging techniques--lung scintigraphy and helical CT--are the diagnostic methods of choice. A normal perfusion lung scan can safely exclude PE. However, 55-65% of patients have indeterminate lung scan results, making additional imaging tests necessary. Helical CT is increasingly being used as the first-line test because it can directly visualize a thromboembolus, it can suggest an alternative diagnosis, and there is excellent inter-observer agreement. A normal helical CT, followed by compression ultrasonography of the leg veins, can safely rule out PE. Finally, the safety of withholding anticoagulant treatment from patients with a normal multi-row detector helical CT as the sole test has not yet been demonstrated.     

Diagnostic strategies for suspected pulmonary embolism.

Pulmonary embolism often remains a difficult diagnosis for the clinician, particularly in patients with comorbidity factors. This is in contrast with the availability of effective treatment, which should be prescribed as soon as possible. To date, there is still no ideal diagnostic test that is accurate, safe, readily available and cost-effective. Recent technical advances in computed tomography, magnetic resonance imaging and laboratory findings have raised new possibilities in the diagnosis of pulmonary embolism. This review covers the performance of different diagnostic tests, and focuses on the advantages and limitations of single diagnostic tests and the clinical usefulness of these tests in diagnostic strategies.     

心电图在急性肺栓塞诊断中的应用价值研究

目的：分析心电图在急性肺栓塞诊断中的应用价值。方法抽取我院收治的临床确诊为急性肺栓塞患者54例,对其临床表现及心电图检查结果进行统计分析。结果本组54例患者发生心电图改变52例,包括窦性心动过速40例,室上性心动过速2例,房性早搏38例,TV1～TV3同时出现倒置17例,出现 SⅠQⅢTⅢ9例,右束支传导阻滞12例。结论急性肺栓塞患者会出现明显的心电图改变,掌握心电图变化特点对于急性肺栓塞的诊断具有重要意义,值得推广应用。     

Diagnostic strategies for suspected pulmonary embolism among outpatients

Diagnosis of pulmonary embolism (PE) has been made easier, less invasive, and somewhat safer over the past 2 decades. This has been due mainly to the development of lung scan and to the recognition of VTE as an entity comprising deep vein thrombosis and PE. The prevalence of the disease in patients clinically suspected of PE has steadily decreased during the past 10 years. This has led to the development of diagnostic tools that aim at reducing the number of unnecessary pulmonary angiograms. These include clinical probability assessment and fibrin D-dimer. Several strategies combining these tools have been validated in large outcome studies and compared in a formal cost-effectiveness analysis. The results indicate that they should now be implemented in daily practice taking into account local facilities and expertise. The exact place of helical computed tomography in such sequential algorithms remains to be established.     

Diagnostic value of the electrocardiogram in suspected pulmonary embolism

The electrocardiogram is shown to be of limited diagnostic value for determining pulmonary embolism in a prospective cohort study of unselected patients with suspected pulmonary embolism.     

多种检测措施在肺栓塞中的诊断价值

目的探讨多种检测方法在肺栓塞中的诊断价值。方法 110例疑为肺栓塞者行肺动脉血管照影(CTA),分析CTA联合血清D-二聚体的诊断价值,并根据D-二聚体和CRP水平分为高危组和低危组。结果依据临床标准,46例确诊肺栓塞;依据CTA确诊41例,另17例为非确定诊断,其诊断的灵敏性和特异性分别为89.13%和81.25%,当以血清D-二聚体500 mg/L为临界值,17例非确定诊断中有8例被确诊为阴性,两者联合使诊断的特异性提高至93.75%。高危组肺梗死占10.52%,心肌损伤26.32%,与低危组比差异有统计学意义(P0.05)。结论血清D-二聚体可辅助确诊CTA中的不确定性诊断病例,从而提高诊断特异性和判断预后。     

Diagnostic and prognostic value of continuous Doppler in pulmonary embolism

A prospective study of 18 patients admitted to hospital for acute pulmonary embolism confirmed the reliability of continuous wave cardiac doppler as a non-invasive method of evaluating systolic pulmonary artery pressures. These pressures were calculated by applying the simplified Bernoulli equation to the maximal velocity of regurgitant tricuspid flow and compared with the results of cardiac catheterisation and angiography, the percentage of vascular obstruction being assessed using Miller's index. The correlations between the two methods were good, r = 0.96; p less than 0.001, with a standard error of +/- 5.2 mmHg. The correlations between the velocity of tricuspid flow and the percentage of obstruction were less significant (r = 0.65; p less than 0.005) but improved when patients with pre-existing cardiopulmonary disease were excluded. This technique of non-invasive assessment of haemodynamic parameters also helps in evaluating the underlying pathology; tricuspid regurgitation with velocities greater than 3.5 m/s is associated with pre-existing chronic cor pulmonale, information of prognostic interest which would guide therapeutic management.