提高对急性肺栓塞的认识课件.ppt

提高对急性肺栓塞的认识提高对急性肺栓塞的认识日照市人民医院心内科丁焕焕从静脉系统( 从静脉系统( Venous system) Venous system) 或或右心右心(Right heart) (Right heart) 脱落的栓子脱落的栓子(Embolus) (Embolus) 堵塞动脉称为肺动脉堵塞动脉称为肺动脉栓塞栓塞(Pulmonary embolism ) (Pulmonary embolism ) 。。肺栓塞肺栓塞肺梗死: 肺梗死: (pulmonary infarction) (pulmonary infarction) 肺组织因肺栓塞,肺动脉或肺肺组织因肺栓塞,肺动脉或肺静脉血栓形成所引起的缺血坏死。静脉血栓形成所引起的缺血坏死。患病率患病率?年龄越大——越高?大于 60岁—— 22% ?65岁以上—— 38% ?80岁以上—— 41% ?30-40岁(非产科,非心衰,非心肌病) _____ 很少?有人统计—— 136 例:平均年龄 (Etiology) (Etiology) ?下肢或盆腔静脉血栓形成(DVT) ?各种因素: ? 1 a 心肌梗死、 b 心房纤颤、 c 心脏瓣膜病、 d 心肌病、 e 充血性心力衰竭。?2 脾切除、右心导管术、盆腔、下肢骨科手术。 3 妊娠与分娩。?4 肿瘤?5 红细胞增多症。?6 长期卧床。?7 蹲坐位时间过长。?8 失血过多,脱水。?9 骨折。?10 肥胖。?11 静脉曲张。?12 过去有血栓栓塞病史。?13 某些药物,如口服避孕药,雌激素?引起肺栓塞的栓子来源部位?静脉血栓形成部位占肺栓塞中的比例? -95% ? -% ?盆腔(前列腺静脉) -% ?上肢罕见?引起肺栓塞的栓子来源部位?静脉血栓形成部位占肺栓塞中的比例? -95% ? -% ?盆腔(前列腺静脉) -% ?上肢罕见 Risk Factors: Risk Factors: ? Age 40-60 years ? Age > 60 (count as 2 factors) ? History of DVT or PE (count as 5 factors) ? Malignancy ? Obesity (>120 % of IBW) ? Previous or present immobilization (>72hrs) ? Anticipated immobilization/bed confinement >72 hrs ? Major Surgery ? Paralysis ? Trauma ? Indwelling central venous catheter ? Crystalloid IV infusion (>5L/24hrs) ? Severe COPD ? Pregnancy, or post partum < 1 month ? Inflammatory bowel disease ? Severe sepsis ? Hypercoagulable state ? Nephrotic Syndrome ? Current or previous estrogen use w/in last 5 days ? Leg ulcers, edema, or stasis (varicose veins) ? History of MI ? History of CHF ? History of Stroke