矛盾性栓塞八例临床分析

目的提高对矛盾性栓塞的认识，减少误诊和漏诊。方法采用病例分析和文献复习的方法。结果本组8例肺栓塞合并矛盾性栓塞患者，男性6例、女性2例；平均年龄为47．6岁。3例发生脑血管栓塞，2例为肾动脉栓塞，左心房血栓、下肢动脉和主动脉栓塞各1例；3例发现卵圆孔开放合并右向左分流。确诊矛盾性栓塞是发现嵌顿于动静脉交通处的栓子，其余皆为临床诊断。本组矛盾性栓塞诊断，7例为临床诊断，1例为确诊。结论矛盾性栓塞并非少见，应加强诊断意识。对于静脉血栓栓塞症合并体循环动脉栓塞或不明原因的体循环动脉栓塞应考虑到矛盾性栓塞可能。

Clinical analysis of 8 cases of paradoxical embolism

Objective To describe the clinical features of paradoxical embolism and therefore to improve its diagnosis.Methods Case analysis and literature review.Results Eight cases of pulmonary embolism complicated with paradoxical embolism were diagnosed,of whom there were six men and two women(mean age,47.6 years).Patent foramen ovale with right to left shunt was identified in only 3 cases.Cerebral embolism occurred in three patients,kidney artery embolism in 2 patients,left atrial thrombus in(1 patient,)lower limb artery and aortic embolism in 1 patients respectively.The diagnosis of paradoxical embolism can only be confirmed when a venous thrombus was detected lodged at arterial-venous communication;otherwise,paradoxical embolism was considered a clinical diagnosis.Of the 8 cases,7 were clinically diagnosed,while 1 was confirmed.Conclusions Paradoxical embolism is not uncommon.The diagnosis should be considered when venous thromboembolism is complicated with systematic embolism or unknown cause of systematic embolism.