急性肺栓塞心电图课件.ppt

Major risk factors Minor risk factors Major abdominal/pelvic surgery大的腹部或骨盆手术 Cardiac failure Recent hip/knee replacement髋、膝关节置换术后近期 Recent MI Postoperative intensive care术后重症监护 hypertension Late pregnancy妊娠后期 Superficial venous thrombosis Caesarean section剖宫产术 Indwelling central vein catheter Lower limb fracture下肢骨折 Oral contraceptive Varicose veins静脉曲张 Hormone replacement therapy Abdominal/pelvic malignancy腹部或骨盆的恶性肿瘤 COPD and IBD Advanced malignancy恶性肿瘤进展期 Serious infection Immobility制动 Obesity Previous venous thromboembolism以前静脉血栓栓塞病史 Nephrotic syndrome Long-distance travel polycythaemia “Massive PE”: hemodynamic instability with SBP 90 or a drop in baseline SBP by /=40mmHg Signs as before PLUS: Acute right heart failure Elevated J.V.P. Right-sided S3 Parasternal lift * Clinical Signs and Symptoms of DVT? (Calf tenderness, swelling 3cm, errythema, pitting edema affected leg only) +3 PE Is #1 Diagnosis, or Equally Likely +3 Heart Rate 100 +1.5 Immobilization at least 3 days, or Surgery in the Previous 4 weeks +1.5 Previous, objectively diagnosed PE or DVT? +1.5 Hemoptysis +1 Malignancy w/ Rx within 6 mo, or palliative? +1 6: High Risk 2 to 6: Moderate Risk 2 or less: Low Adapted with permission from Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED d-dimer. Thromb Haemost 2000;83:416-20. 胸部X线 平片72%提示有肺栓塞征象，如区域性肺血减少，肺血分布不匀，或有肺阴影、胸腔积液等，而冠心病胸部X线平片多数正常，有心功能不全者，可显示肺淤血改变，与肺血减少不同。 7．肺栓塞超声心动图显示右心室、右心房扩大，心室间隔左移，左室内径缩小，肺动脉压升高，与以左心室病变为主的冠心病截然不同。 8．动脉血气检查，有症状的肺栓塞患者多有PaCO2下降，pH 升高，PA-aO2 增加，PaO2 下降或正常，而冠心病除非合并肺淤血，一般血气正常 胸部X线 平片72%提示有肺栓塞征象，如区域性肺血减少，肺血分布不匀，或有肺阴影、胸腔积液等，而冠心病胸部X线平片多数正常，有心功能不全者，可显示肺淤血改变，与肺血减少不同。 7．肺栓塞超声心动图显示右心室、右心房扩大，心室间隔左移，左室内径缩小，肺动脉压升高，与以左心室病变为主的冠心病截然不同。 8．动脉血气检查，有症状的肺栓塞患者多有PaCO2下降，pH 升高，PA-aO2 增加，PaO2 下降或正常，而冠心病除非合并肺淤血，一般血气正常 A young gentleman with shortness of breath and left l