课件：急性肺血栓栓塞症诊断及治疗.ppt

小 结 急性肺栓塞目前已得到临床医师的高度重视，早期诊断率不断提高，越来越多患者得到及时治疗，早期死亡率有明显下降趋势。但仍有相当多临床医师尤其是基层医院医师对急性肺栓塞的诊断意识较薄弱，规范化诊治流程不熟悉，更缺乏急性大块肺栓塞溶栓抢救经验。本专家共识旨在提高我国临床医师对急性肺栓塞的诊断意识，规范临床诊治行为，制定适合我国国情的溶栓治疗方案，尤其对绝大多数无法开展外科治疗的医院积极开展溶栓治疗急性大块肺栓塞具有重要意义。 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * * * * VTE is often silent and difficult to diagnose : Approximately 80% of all DVTs are silent 2. DVT often goes under-diagnosed as it is frequently asymptomatic. When symptoms do occur they are non-specific (pain in the calves or thigh muscles and swelling). Similar symptoms can occur with simple muscle strains or streptococcal infections. Often, a definitive diagnosis can only be reached when one of the following tests has been carried out 4 : 1) Venography. 2) Impedance phlethysmography. 3) Venous ultrasound. Silent VTE may develop into PE which itself may go unrecognized. PE is often asymptomatic and even when symptoms do appear they may be difficult to recognize 5. Consequently, less than half of all cases of fatal pulmonary embolism (PE) are detected prior to death 1. 1. Goldhaber SZ, Hennekens CH, Evans DA, Newton EC, Godleski JJ. Factors associated with correct antemortem diagnosis of major pulmonary embolism. American Journal of Medicine 1982;73:822-826. 2. Lethen H, Flachskampf FA, Schneider R, et al. Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. American Journal of Cardiology 1997;80:1066-1069. 3. Sandler DA, et al. J. Royal Soc. Med. 1989; 82:203-205. 4. Lensing AWA, Prandoni P, Prins MH et al. Deep vein thrombosis. Lancet 1999; 353:479-485. 5. Alpert JS, Dalen JE. Epidemiology and natural history of venous thromboembolism. Progress in Cardiovascular Diseases 1994; 36 (6):417-422. The number of patients affected by venous thromboembolism (VTE) has been estimated to be: - Deep venous thrombosis (DVT) – up to 145 patients per 100 000 population (age- and sex adjusted to the US 1980 white population) 1,2