血栓性疾病系列讲座之血栓性疾病的防治 - 浙江省台州医院.ppt

VENOUS THROMBOEMBOLISM(VTE)
DEEP VENOUS THROMBOSIS (DVT)
PULMONARY THROMBOEMBOLISM(PTE)
浙江省台州医院呼吸科
吕冬青
与肺栓塞有关的名词
肺栓塞(pulmonary thrombosis,PE)
肺血栓栓塞(pulmonary thrombembolism,PTE)
深静脉血栓形成(deep venous thrombsis,DVT)
静脉血栓栓塞症(venous thromboembolism, VTE)
肺梗死(pulmonary infarction)
TOPICS
概念、流行病学、病理生理
危险因素、临床表现、辅助检查
3. 诊断策略
4. 治疗方法
5. 预防措施
PTE-DVT—不容忽视的国际性医疗保健问题
Pulmonary embolism in USA (annual)
Prevalence:650,000 cases annually(1 in 418 or %)
Death:9,000 Hospitalizations : 90,000  Society statistics for Pulmonary embolism (NHLBI)
(Patient Safety in American Hospitals, Health Grades 2004)
Pulmonary embolism in England (annual)
Prevalence: 23,699 (%)
91% required emergency hospital admission
Death rate: 6%-18%
Hospital Episode Statistics, Department of Health,
England, (2002-03) BTS guideline 2003
PTE-DVT—不容忽视的国际性医疗保健问题
Country/Region
Extrapolated Incidence
Population Estimated Used
Pulmonary embolism in Aisa (Extrapolated Statistics)
China
3,103,863
1,298,847,624
India
2,545,205
1,065,070,6072
Japan
304,288
127,333,0022
Hong Kong
16,381
6,855,125
Pulmonary embolism in Europe (Extrapolated Statistics)
Belgium
24,729
10,348,2762
France
144,396
60,424,2132
Germany
196,970
82,424,6092
/ pulmonary embolism/stats-
诊断策略
根据临床情况疑诊PTE
PTE临床可能性预测
危险因素(遗传/获得)、临床
D-Dimer检测
X线胸片、 ECG、 ABG
超声检查:心脏,下肢静脉
对疑诊病例排进行确诊检查(及时、迅速)
CTPA;核素V/Q;MRPA;PAA
寻找PTE病因(求因)
Virchow’s 三要素& 血栓形成
All aspects of this triad can be disrupted in:
获得性危险因素
遗传性危险因素
血流淤滞
高凝状态
血管壁损伤
PTE-DVT原发性危险因素
抗凝血酶III、Ⅻ因子、蛋白S、蛋白C缺乏
先天性异常纤维蛋白原血症
血栓调节因子(thrombomodulin)异常
高同型半胱氨酸血症(hyperhomocysteinemia)
抗心脂抗体综合征(anticardiolipin antibody )
纤溶酶原激活物抑制因子过量
凝血酶原20210A基因变异
Ⅴ因子Leiden突变(活性蛋白C抵抗)
纤溶酶原缺乏/纤溶酶原不良血症
危险因素-获得性
手术
骨折
创伤
制动
肿瘤
外伤肥胖
偏瘫
妊娠和口服避孕药
高龄
DVT
加强识别和预防DVT-PTE意识