【2017年整理】急性肺栓塞与急性冠脉综合征的鉴别.ppt

急性肺栓塞与急性冠脉综合征的鉴别APE or ACS？ Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 在美国静脉血栓栓塞症（VTE）是仅次于心肌梗死和卒中第三位最常见的心血管疾病，急性肺栓塞3个月内的病死率超过15%，并超过心肌梗死和卒中，又是一个完全可以治好的病，与冠心病不同。 当前我国肺栓塞面临的最大问题是高误诊、漏诊率（至少80%） Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 过去误诊率90%-98% Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 国内外误诊中50%以上是冠心病，其中大部分是急性冠脉综合征（ACS） Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. APE in CCU 在CCU198例严重心衰患者中9.1%发生PE，即使已接受血栓预防； 1032例住院心脏病患者尸检中，24.4%有PE，9.7%为大块肺栓塞，其中死前未怀疑PE者82%； 在CCU诊断PE很困难，许多表现类似ACS或心衰，APE患者胸痛、心电图改变、心肌损伤标志物均为ACS共有，提高诊断意识至关重要。 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. APE与ACS相似之处 胸闷：劳力性呼吸困难或劳力性心绞痛？ 胸痛：胸膜痛(累及胸膜，与呼吸有关)或心绞 痛？ Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 心电图改变 ACS：相邻二个以上的导联ST段抬高大于0.1 mV的患者，91%以上可以诊断心梗；ST段出现低值可以诊断为不稳定性心绞痛或者非抬高心肌梗死，这类患者的冠脉造影绝大多数显示有血栓形成的复杂病理改变 APE：SIQIIITIII “冠状T”V1-4 68%—PE（LAD缺血） Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. “冠状T” 1.5mV Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 心电图改变 ST段抬高性心肌梗死图型：急性肺栓塞心电图改变常呈一过性或时序性，需动态观察、比较，一日数图。 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Pr