PE的治療除一般治療外,積極溶栓及抗凝治療是成功的關(guān)鍵。溶栓治療[14] 可迅速溶解血栓和恢復(fù)肺組織再灌注,逆轉(zhuǎn)右心衰竭,改善肺毛細(xì)血管容量及降低病死率和復(fù)發(fā)率。有效率在80%以上。同時(shí)溶解外周靜脈血栓,降低PE的復(fù)發(fā)率[1];抗凝治療[15]可防止栓塞發(fā)展和再發(fā),病人心功能獲得改善[1]。有建議臨床可疑肺栓塞時(shí)即可進(jìn)行有效的抗凝治療[16]。本組15例(88%)住院期間存活的病人治療后心功能均改善,呼吸困難、胸悶等癥狀基本緩解。
綜上所述,PE臨床表現(xiàn)無特異性,極易造成誤診,目前隨著臨床醫(yī)師對(duì)PE的診斷意識(shí)的提高,結(jié)合相應(yīng)必備的檢查設(shè)備的完善,有針對(duì)性地進(jìn)行特異性檢查,及時(shí)正確治療,PE的漏診率和誤診率、病死率將會(huì)不斷降低。
【參考文獻(xiàn)】
1王吉耀,廖二元,胡品津.內(nèi)科學(xué).北京:人民衛(wèi)生出版社,2005,61-68.
2Ansari A.Acute and chronic pulmonary thrimbodysis current perspectives Part 1:Glossry terms historic evolution and prevalence. Clin Cardio,1998,9(8):398-402.
3Goldhaber SZ,Morpurgo M.Diagnosis,treatment and prevention of pul-monary embolism.JAMA,1992,268:1727-1732.
4Wolle TR,Allen TL.Syncope as an emergency department presentation of pulmonary embolism.J Emergency Med,1998,16:27-31.
5何權(quán)瀛.努力提高肺栓塞的早期診斷率.中國醫(yī)藥導(dǎo)刊,2001,3:9-10.
6Goldhaber SZ,Visani L,De Rosa M.Acute pulmonary embolism:chini-cal outcoms in the International Cooperative Pulmonary Embolism Reg-istry(ICOPER).Lancet,1999,353:1386-1389.
7程顯聲. 肺血管疾病學(xué).北京:北京醫(yī)科大學(xué)、中國協(xié)和醫(yī)科大學(xué)聯(lián)合出版社,1993,179-194.
8Sasahara AA.Detection of deep vein thrombosis in the diagnosis of pul-monary embolism.J Nucl Med,1986,30(1):57.
9許曉紅,陳潔.不典型肺動(dòng)脈栓塞14例誤診分析.內(nèi)蒙古醫(yī)學(xué)雜志,2007,39(7):809-810.
10Mc Connell MV,Solomon SD,Rayan ME,et al.Regional right ventricular dysfunction by echocardiography in acute pulmonary embolism.Am J Cardiol,1996,78:469-473.
11柳志紅,趙彥芬.急性肺栓塞診斷治療現(xiàn)狀.中國循環(huán)雜志,2002,3:171-172.
12張勁松,李琳,陳旭峰,等.急性肺栓塞96例分析.江蘇醫(yī)藥,2008,34(11):1166-1167.
13姜儉,孫異鋒,米濤.肺栓塞30例臨床分析.中華全科醫(yī)學(xué),2009,12(7):1324-1324,1343.
14Arcasoy SM,kreit JW.Thrombolytic therapy of pulmonary embolism-A comprdensive review of current evidence.Chest, 1999,115(6):1695-1707.
15Krivec B,Voga G,Zumn L, et al.Diagnosis and treatment of shock due to massive pulmonarym1bolism.Chest, 1997,112(5):1310-1316.
16趙水平,胡大一.心血管病診療指南解讀.北京:人民衛(wèi)生出版社,2004,378-380.