急性肺动脉栓塞及进展-心内科何国祥

Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 12. Estimated case fatality rates for PE according to decades of age. (Reprinted with permission.23)
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 2. Deep venous thrombosis (DVT)/100,000 population/year shown according to age for the year 1999.6,7 (Reprinted with permission.10)
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
Update in 2010
中国急性肺血栓栓塞症诊断治疗专家共识
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
1、背景
2、临床评估 3、定量评估 4、治疗 抗凝 溶拴 手术
导管治疗
5、妊娠PE 6、非血栓PE
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
1、背景
2、临床评估 3、定量评估 4、治疗 抗凝 溶拴 手术
导管治疗
5、妊娠PE 6、非血栓PE
Hale Waihona Puke Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 1. Venous thromboembolism (VTE)/100,000 population/year from 1990 through 1999.(Data from Stein et al.3-5)
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 4. PE and DVT in children. (Data from Stein et al.7)
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
Major risk factors for venous thrombosis
• Major surgery • Orthopaedic surgery to lower limb/lower limb trauma • History of previous venous thrombosis • Cancer • Pregnancy/puerperium • Reduced mobility – major illness with prolonged bed rest
Data from Stein et al.29,57 Reprinted with permission.10 Some patients had more than 1 abnormality. Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 3. Pulmonary embolism (PE)/100,000 population/year shown according to age for the year 1999. (Data from Stein et al.5,6) (Reprinted with permission.10)
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
Three images from a single computed tomography pulmonary angiography (CTPA) study performed with a high clinical suspicion of pulmonary embolism (PE). Image 1 demonstrates a large PE in the proximal right pulmonary artery. Image 2 shows a significant concurrent pneumothorax. Image 3 demonstrates an RV/LV ratio >1 signifying significant right ventricular (RV) dysfunction. Together these images show the high utility of CTPA in diagnosis/exclusion of PE, Southwest Hospital diagnosis/exclusion of differential diagnoses, and in risk stratifying a patient so as to guide therapy.
• Age >70 years
• Thrombophilias: antithrombin deficiency protein C deficiency
protein S deficiency
antiphospholipid antibodies
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
Curr Probl Cardiol 2010;35:314-376
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 20. CT pulmonary angiogram showing PE in the right pulmonary artery.
肺实质异常 肺不张/萎陷 肺实变 胸水
Data are from Stein et al.29,63 Reprinted with permission.10 aAmong patients with a pleural effusion, 86% had only blunting of the costophrenic angle. None had a pleural effusion that occupied more than one third of a hemithorax. bProminent central pulmonary artery and decreased pulmonary vascularity.
急性肺栓塞诊疗指南及进展
Guidelines and Progress on the Diagnosis and Management of Acute Pulmonary Embolism
何国祥
Prof. Guoxiang HE
第三军医大学西南医院 重庆市介入心脏病学研究所
Southwest Hospital The Third Military Medical University Chongqing Institute of Interventional Cardiology
1、背景
2、临床评估 3、定量评估 4、治疗 抗凝 溶拴 手术
导管治疗
5、妊娠PE 6、非血栓PE
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
TABLE 5. Electrocardiographic manifestations: patients without prior cardiac or pulmonary disease
Southwest Hospital
Guidelines and Progress on the Diagnosis and Management of Acute PE
FIG 19. Relative use of diagnostic imaging tests in patients hospitalized with PE from 1979 through 2006. V/Q, ventilation/perfusion; ANGIOS, pulmonary angiograms. (Reprinted with permission.10)