【摘要】 [目的]探讨下肢深静脉血栓形成(DVT)致急性肺栓塞的诊断与治疗方法。[方法]对78例DVT并发肺栓塞患者,根据病史及临床表现,高度疑似肺栓塞发生时,急查凝血功能,排除凝血功能障碍,立即皮下注射低分子肝素抗凝治疗,在病情许可的情况下急查肺动脉CTA,明确诊断;分别抗凝;静脉溶栓;呼吸循环支持治疗;活血化瘀药物及对症治疗;置入下腔静脉滤器。根据临床症状、血气分析及影象学检查评定疗效。[结果]78例患者经综合治疗48 h后,患者生命体征及动脉血气分析明显好转。有效69例,有效率达88.5%。[结论]DVT患者高度疑似肺栓塞发生时,抗凝与检查同时进行,首先皮下注射低分子肝素抗凝治疗,明确诊断后实施以抗凝为主联合溶栓及呼吸循环支持治疗,活血化瘀药物治疗及对症治疗,可明显改善预后,降低病死率。置入下腔静脉滤器可有效预防致死性肺栓塞发生。更多还原

【Abstract】 [Objective]To explore simple and effective diagnosis and treatment for acute pulmonary embolism caused by DVT.[Methods]78 cases of DVT with pulmonary embolism, based on history and clinical manifestations,when highly suspected pulmonary embolism occurs, detected coagulation immediately to exclude coagulopathy, subcutaneous low molecular weight heparin immediately, in the case of the condition permits, checked pulmonary CTA immediately to diagnosis; respectively anticoagulant; intravenous thrombolysis; respiratory and circulatory support therapy; blood circulation drugs and symptomatic treatment; placement of an inferior vena cava filter. Based on clinical symptoms, blood gas analysis and imaging examination evaluated.[Results]78 patients after comprehensive treatment for 48 h, the patient ’s vital signs and arterial blood gas analysis significantly improved. Effective in 69 cases, the effective rate was 88. 5%; markedly effective in 6 cases; invalid in 1 patient;deterioration of two cases; 3 cases of bleeding complications.[Conclusion]When patients are suspected with pulmonary embolism,anticoagulation and inspection should be done at the same time. hypodermic injection of low molecular weight heparin is the frist therapy,after diagnosis,therapy of anticoagulation basted, thrombolysis, respiratory and circulatory support,drugs promoting blood circulation and symptomatic treatment can and reduce mortality. Placed in the inferior vena cava filters can be effective in preventing fatal pulmonary embolism.更多还原