CAJ | 학술논문

目的提高对急性肺栓塞合并矛盾性栓塞的临床特点及疗效的认识,减少误诊和漏诊,为制定正确的诊治策略提供依据.方法回顾性分析我院1963年至2011年临床诊断或经尸体解剖诊断的急性肺栓塞合并矛盾性栓塞病例.结果急性肺栓塞合并矛盾性栓塞患者12例,男10例,女2例,平均年龄(73±12)岁.伴休克11例,伴晕厥7例,呼吸骤停1例；肺动脉血栓栓塞部位均位于肺动脉主干、骑跨于主肺动脉分叉处或左、右肺动脉干,伴有双侧、多叶段肺动脉栓塞；均有右室增大,卵圆孔开放5例,右心房、右心室血栓3例,左心房血栓3例,卵圆孔骑跨栓3例.体循环动脉栓塞最多见的是脑动脉栓塞(5例),其他有下肢动脉、肾动脉、肝脾动脉及冠状动脉栓塞.临床诊断5例,溶栓治疗3例,均治愈；血栓清除术1例,治愈；单纯抗凝治疗1例,死亡.7例在发病2～6 h死亡,经尸体解剖诊断.结论急性肺栓塞合并矛盾性栓塞临床并非罕见,血流动力学不稳定,病死率高,应加强诊断意识.临床诊断后及时给予溶栓治疗,可有效改善血流动力学,提高生存率,有溶栓禁忌证及血流动力学持续不稳定可考虑手术清除血栓.
목적 제고대급성폐전새합병모순성전새적림상특점급료효적인식,감소오진화루진,위제정정학적진치책략제공의거.방법 회고성분석아원1963년지2011년림상진단혹경시체해부진단적급성폐전새합병모순성전새병례.결과 급성폐전새합병모순성전새환자12례,남10례,녀2례,평균년령(73±12)세.반휴극11례,반훈궐7례,호흡취정1례；폐동맥혈전전새부위균위우폐동맥주간、기과우주폐동맥분차처혹좌、우폐동맥간,반유쌍측、다협단폐동맥전새；균유우실증대,란원공개방5례,우심방、우심실혈전3례,좌심방혈전3례,란원공기과전3례.체순배동맥전새최다견적시뇌동맥전새(5례),기타유하지동맥、신동맥、간비동맥급관상동맥전새.림상진단5례,용전치료3례,균치유；혈전청제술1례,치유；단순항응치료1례,사망.7례재발병2～6 h사망,경시체해부진단.결론 급성폐전새합병모순성전새림상병비한견,혈류동역학불은정,병사솔고,응가강진단의식.림상진단후급시급여용전치료,가유효개선혈류동역학,제고생존솔,유용전금기증급혈류동역학지속불은정가고필수술청제혈전.
Objective To improve recognition of acute pulmonary embolism complicated with paradoxical embolism(PDE) and provide evidence for diagnosis and treatment for PDE.Methods The data of patients with acute pulmonary embolism complicated with PDE determined by clinical diagnosis or autopsy from 1963 to 2011 were retrospectively analyzed.Results 12 cases of acute pulmonary embolism complicated with PDE were diagnosed,ten male and two female,the average age was (73±12) years old.11 cases had shock,seven cases had syncope,and one case had respiratory arrest.Pulmonary thromboembolisms were located in pulmonary trunk,straddling the bifurcation of the pulmonary trunk or located in left and right pulmonary artery trunk.All the cases accompanied by bilateral multi-leaf segment pulmonary embolism.All the patients had increased right ventricular.Five cases had opening foramen ovale,three cases had left atrium,right atrium and right ventricle thrombus,and three cases had foramen ovale riding a cross-bolt.Systemic arterial thromboembolism was mainly cerebral artery embolization (five cases).Others included lower extremity arterial embolism,renal artery embolization,liver and spleen artery embolization,and coronary thrombosis.In five cases by clinical diagnosis,three cases took thrombolytic therapy and were cured,one case took thromboembolectomy and was cured,one case took anticoagulant therapy and had death.Seven cases died between two to six hours after the onset of the disease and were confirmed by autopsy.Conclusions Acute pulmonary embolism complicated with PDE is not uncommon.Hemodynamic instability,high mortality bave been recognized in acute pulmonary embolism combined PDE.Diagnostic awareness should be enhanced.Thrombolytic therapy should be taken immediately after diagnosis.For patients with thrombolytic contraindications and continuely instable hemodynamics,surgery can be taken to remove blood clots.