下肢深静脉血栓合并肺动脉栓塞的临床诊治分析

Clinical Diagnosis Analysis on Pulmonary Artery Embolism complicated from Deep Vein Thrombus of Lower Limb

目的：探讨下肢深静脉血栓合并肺动脉栓塞的临床诊治方法及效果。方法：回顾性分析我院2000年1月～2006年6月期间收治的下肢深静脉血栓合并肺动脉栓塞的诊断、治疗经过及一个月的随访结果。结果：32例患者进行肺动脉造影术8例，肺动脉导管裂栓术3例，经导管肺动脉内溶栓7例，植入下腔静脉滤器30枚，经下肢静脉溶栓30例；死亡2例，其中1例死于肺动脉造影时，另1例死于溶栓后脑出血。结论：（1）肺动脉栓塞缺乏特异性的临床表现，容易误诊，应加强认识。（2）心电图、血气分析、D-二聚体、16层CT、肺血流灌注扫描、下肢静脉彩色超声、肺动脉造影等检查都具有各自的有优缺点，应合理应用。（3）肺动脉介入治疗及溶栓治疗都能安全有效地治疗肺动脉栓塞。（4）下腔静脉滤器预防下肢静脉血栓引起的肺动脉栓塞的疗效肯定。

Objective：To discuss the clinical diagnosis method and effect for pulmonary artery embolism complicated from lower limb deep vein thrombus. Methods： The results of diagnosis, treatment and a months follow up of patients in the First Hospital Affiliated of NanChang University in the years 2000.1-2006.6 were retrospective analyzed. Results： Among 32 patients of lower limb deep vein thrombus merge pulmonary artery embolism, 8 showed lung arteriography; 7 did pulmonary artery canula catheter directed thromholysis; 30 did Implantation inferior vena cava filter; lower extremity thrombolysis 30; two cases died, one died of pulmonary arteriography, the other one died of cerebral hemorrhage. Conclusion： （1）the pulmonary artery embolism lacks the specific clinical manifestation and is easy to misdiagnose, should be emphasized. （2）the electrocardiogram, the courage vigor analysis, the D-dimer, 16 CT, the lung blood stream pours into the scanning, the lower limb vein colored supersonic, the pulmonary artery radiography and so on all has respective advantage and shortcoming, we should apply in reason. （3）the pulmonary artery involvement treatment and dissolves the hitch treatment all to be able safely effectively to treat the pulmonary artery embolism. （4） the inferior vena cava filters prevention lower limb vein thrombus causes pulmonary artery embolism curative effect affirmation.