CAJ | 학술논문

目的探讨肺动脉栓塞(PE)合并脑动脉栓塞的诊断与治疗方法.方法回顾性分析2007年10月至2011年7月厦门大学附属中山医院5例肺动脉栓塞合并脑动脉栓塞的临床资料,并复习有关文献.结果 5例患者均为女性,平均年龄为46.5岁,均通过增强肺部CT及肺ECT证实为肺动脉栓塞,经超声心动图检查发现均有中-重度肺动脉高压,2例卯圆孔未闭,1例为先天性房间隔缺损.5例患者均经头部MRI诊断为新发脑梗死.3例采用溶栓治疗,5例均给予抗凝治疗.5例患者经治疗均存活,且长期服用华发令,INR控制在2.0～2.5之间,1例患者脑栓塞3d后再次出现脑栓塞,4例患者随访未再次发生体循环系统栓塞.结论矛盾性脑栓塞并非少见,应加强诊断意识.对于肺动脉栓塞,尤其是肺动脉高压合并体循环动脉栓塞或不明原因的脑动脉栓塞,应考虑到矛盾性栓塞可能.
목적 탐토폐동맥전새(PE)합병뇌동맥전새적진단여치료방법.방법 회고성분석2007년10월지2011년7월하문대학부속중산의원5례폐동맥전새합병뇌동맥전새적림상자료,병복습유관문헌.결과 5례환자균위녀성,평균년령위46.5세,균통과증강폐부CT급폐ECT증실위폐동맥전새,경초성심동도검사발현균유중-중도폐동맥고압,2례묘원공미폐,1례위선천성방간격결손.5례환자균경두부MRI진단위신발뇌경사.3례채용용전치료,5례균급여항응치료.5례환자경치료균존활,차장기복용화발령,INR공제재2.0～2.5지간,1례환자뇌전새3d후재차출현뇌전새,4례환자수방미재차발생체순배계통전새.결론 모순성뇌전새병비소견,응가강진단의식.대우폐동맥전새,우기시폐동맥고압합병체순배동맥전새혹불명원인적뇌동맥전새,응고필도모순성전새가능.
Objective To explore the diagnosis and treatment of cerebral embolism from pulmonary embolism (PE).Methods The clinical data of 5 cases with PE accompanied by cerebral embolism covering a period from October of 2007 to July of 2011 were retrospectively analyzed.Results In this study,the average age of 5 cases (all female) was 46.5 years old.PE was diagnosed through enhanced CT and ECT in lung among all 5 cases.Moderate to severe pulmonary hypertension was confirmed by echocardiogram.Two cases was patent foramen ovale and one was congenital atrial septal defect.Each patient was diagnosed to be new-onset cerebral infarction by MRI.Three cases underwent cerebral arterial thrombolysis.All of them survived and long-term anticoagulant treatment with Warfarin.INR was adjusted between 2.0 and 2.5 by change of Warfarin dose.Among them,one patient had cerebral embolism again just 3 days after the latest cerebral embolism; the other 4 patients did not suffer from cerebral embolism during the follow-up.Conclusions Paradoxical cerebral embolism is common.For clinical patients with PE,especially pulmonary hypertension accompanied by systemic circulation arterial embolism or unexplained systemic cerebral arterial embolism,paradoxical cerebral embolism should be considered.