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yxfbbiedtj · Wysłany: Pon 15:43, 07 Mar 2011

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34 patients with acute pulmonary embolism diagnosis and treatment of early

2 cases of postoperative bed rest for the 1st out of bed after the onset,[link widoczny dla zalogowanych], 1 patient after treatment for the medical intervention after the onset of the 1st out of bed. 6 patients had sudden onset of shortness of breath,[link widoczny dla zalogowanych], sweating,[link widoczny dla zalogowanych], facial extremities, cyanosis,[link widoczny dla zalogowanych], blood pressure <50mmHg, 3 patients with syncope, chest pain in 2 cases, the oxygen, high-dose application of vasoactive drugs, respiratory stimulants, and cardiopulmonary recovery, etc. He died at 1O ~ 60min after the onset of symptoms of clinical death. Autopsy results: saddle embolism in 5 cases of pulmonary artery, right pulmonary embolism in paragraph 1 case, blood clots into the front of the upper and lower pulmonary artery branch in the mouth. More than 3 cases of medical patients, 2 females, 1 male, of which 1 female, aged 52, to repeated syncope half of treatment, electrocardiogram showed SQ Ⅲ T Ⅲ and dynamic evolution, the results of blood gas analysis consistent with acute PTE diagnosis, admission blood pressure after 70 / 50mmHg, anti-shock treatment fails, a half-hour blood pressure to 0, after she died. Another 2 cases of elderly patients, and chronic congestive heart failure, difficulty in breathing during hospitalization increased, blood pressure, check spiral CT, blood gas analysis diagnosed as acute PTE, refused to thrombolysis and anticoagulation, 1 week after the onset death. 3 Discussion of acute PTE is currently no epidemiological data on the West in the general population the incidence of DVT and PTE were about 1 and 0.5, the United States issued each year in patients with DVT-PTE 650 000 ~ 7o million, the fatality rate second only to coronary heart disease and tumor, the composition of the population No. 3 cause of death. Death in patients with acute PTE, 44 died of symptoms occurred within 15min, and the other 22 died within 2h. Confirmed by autopsy in this group of 6 patients with acute PTE were asked the time of death within 1h. Due to lack of specific symptoms and signs, clinical Misdiagnosis rate, up to 67 foreign reports, even if the developed countries who have died of PTE 2O alive without diagnosis. With the diagnosis of clinical physicians PTE increased awareness and diagnostic techniques, combined with the aging of our population, the current incidence of PTE in China showed a rapid increasing trend. Patients to have the underlying cause, such as DVT, prolonged bed rest, lower limb fractures and trauma, chronic heart and lung disease, surgical and medical intervention braking lower extremities, in the event unexplained dyspnea, syncope, shortness of breath, chest pain, low blood pressure, hemoptysis, sinus tachycardia, P and other clinical manifestations or symptoms of hyperthyroidism should be immediately after the thought of the possibility of acute PTE, which line blood gas analysis, ECG, UCG, spiral CT, D dimer, ventilation perfusion lung imaging and other tests, early diagnosis. On left ventricular function associated with failure, patients with massive PTE is the most serious problem of hypotension and shock, this time the most efficient and effective inspection is UCG and spiral CT, once the diagnosis of acute PTE, anticoagulation therapy should start early thrombolysis, The group of 25 patients survived thrombolytic therapy in patients with 11 cases, the total effective rate was 100, with no deaths. 2 patients who died were elderly medical patients, there are indications for thrombolysis, family members refused to thrombolysis, 1 week died of cardiopulmonary failure. For patients with unstable hemodynamics, UCG showed pulmonary hypertension and right ventricular blood of indirect signs of overloading can be used as the only features of thrombolytic therapy, the majority of intravenous thrombolysis contraindication, such as hypertension, after major surgery recent cardiopulmonary resuscitation, recent gastrointestinal bleeding, trauma, etc., on large PTE patients is relative. Rapid thrombolytic therapy is to reduce the mortality of the key. Pulmonary artery thrombolysis thrombolysis can improve the lung tissue perfusion, decreased pulmonary artery pressure and improve heart function, while dissolution of deep vein thrombosis, reducing PTE recurrence and improve prognosis, especially now that the time window of thrombolytic therapy in PTE disease after 14d within the PTE thrombolytic therapy has become the preferred method. Hemodynamic stability and duration for more than 2 weeks or low molecular weight heparin in patients with heparin and warfarin, also effective anticoagulant therapy is the basic treatment of DVT and PTE method can effectively prevent the recurrence of thrombus formation and then, while the body own fibrinolytic mechanisms, the formation of thrombus has been dissolved.