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肺血栓栓塞症的研究进展 总被引:5,自引:0,他引:5
赵玉彤 《中国医学文摘:内科学》2006,27(3):218-221
肺栓塞(pulmonary embolism,PE)是以各种栓子阻塞肺动脉系统为发病原因的一组疾病或临床综合征的总称[1]。肺血栓栓塞症(pumlonary thromboembolism,PTE)是PE的最常见类型,是指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 相似文献
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肺血栓栓塞症的病理与病理生理 总被引:33,自引:1,他引:32
肺血栓栓塞症 (pulmonarythromboembolism ,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临床和病理生理特征。引起PTE的血栓主要来源于深静脉血栓形成 (deepvenousthrombosis,DVT)。PTE与DVT共属于静脉血栓栓塞症 (venousthromboembolism ,VTE)。一、深静脉血栓形成DVT的病理基础是血管内皮损伤、血流淤滞和血液高凝状态。凡可引起以上任一病理基础的临床病理生理改变均可作为独立的危险因素[1] … 相似文献
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低分子肝素与血栓栓塞性疾病 总被引:24,自引:0,他引:24
血栓栓塞性疾病包括动脉粥样硬化血栓性疾病和静脉血栓栓塞性疾病,动脉粥样硬化血栓性疾病涉及冠状动脉、脑动脉和外周动脉;静脉血栓栓塞性疾病(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE)。血栓栓塞性疾病是各种内在和外在因素导致动脉和静脉血管内血栓形成和(或)栓塞并导致组织和器官功能受损的病理过程。治疗的关键是抗血小板和抗凝治疗。传统的抗凝药物主要是未分离肝素, 相似文献
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肺动脉血栓栓塞症,简称肺栓塞(pulmonaryembolism,PE)是指血栓堵塞了肺动脉主干或分支所引起的肺循环障碍,其原因多与深静脉血栓形成有关.临床表现复杂,重者猝死.由于PE突发率高、易误诊、漏诊等原因,急性大面积PE死亡率极高[1],我国最新统计资料显示PE占全部死因的第四位.
急性PE主要常用的治疗方法有抗凝、全身静脉溶栓、导管肺动脉局部溶栓、导管碎栓和除栓、外科手术取栓等.如果患者伴发心脏骤停、休克、大面积致死性肺栓塞或存在明确的溶栓、外科手术禁忌证,导管介入治疗是替代治疗方案之一. 相似文献
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<正> 肺血栓栓塞症(pulmonary thromboembolism,PTE)是指血栓栓子堵塞肺动脉主干和(或)其分支所引起的以肺循环障碍为主要表现的临床病理综合征。为进一步提高PTE的诊断率及治愈率,本研究对我院收治的67例PTE患者进 相似文献
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1 概念及流行病学
慢性血栓栓塞性肺动脉高压(claronic throm boembolic pulmonary hypertension,CTEPH)是指肺动脉及其主要分支由于血栓栓塞所导致的血流受阻,长期不能缓解或进行性加重,导致肺动脉高压.CTEPH是肺血栓栓塞症中的一种特殊类型,是血栓不能完全溶解,或者是在深静脉血栓形成反复脱落的基础上继发反复多次栓塞肺动脉、血栓机化,肺动脉内膜慢性炎症并增厚,发展为慢性肺栓塞.CTEPH进一步发展可出现呼吸功能不全和右心衰竭. 相似文献
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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… 相似文献
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Klok FA Mos IC van Kralingen KW Vahl JE Huisman MV 《Seminars in respiratory and critical care medicine》2012,33(2):199-204
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. 相似文献
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Spagnolo S Grasso MA Tesler UF 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2006,33(4):473-476
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. 相似文献
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Alonso-Martínez JL Anniccherico-Sánchez FJ Urbieta-Echezarreta MA García-Sanchotena JL Herrero HG 《European Journal of Internal Medicine》2012,23(4):379-383
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. 相似文献
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J R Benotti I S Ockene J S Alpert J E Dalen 《Catheterization and cardiovascular diagnosis》1984,10(5):519-527
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. 相似文献
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The pulmonary pressures in pulmonary venous obstruction 总被引:1,自引:0,他引:1
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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. 相似文献
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Morel S Mangiapan G Bassinet L Housset B L'Huillier JP 《Revue des maladies respiratoires》2012,29(5):723-726
Several etiologies are involved in the pathogenesis of cavitating pulmonary disease including neoplastic, infectious or inflammatory processes. Another is pulmonary infarction associated with venous thromboembolism. The lung cavities tend to be located peripherally and are the result of pulmonary embolism. We report the case of a woman with chronic thromboembolic pulmonary hypertension (CTEPH), associated with familial thrombophilia, revealed by cavitating pulmonary infarcts. CTEPH is sometimes diagnosed during an episode of recurrent pulmonary embolism following previously unnoticed lesions. Thrombophilias such as isolated elevated factor VIII are risk factors for CTEPH. 相似文献
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D X Wang 《中华结核和呼吸杂志》1983,6(3):162-165