2008ESC急性肺动脉栓塞指南解读.ppt

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1、Guidelinesonthediagnosisandmanagementofacutepulmonaryembolism——2008ESCClassesofrecommendationsLevelsofevidencePredisposingfactorsPredisposingfactorsforvenousthromboembolism:Table3NaturalhistoryTheriskofVTEaftersurgeryishighestduringthefirst2weeksaftersurgerybutremainselevatedfor2–3months.Antith

2、romboticprophylaxissignificantlyreducestheriskofperioperativeVTE.Thelongerthedurationofantithromboticprophylaxis,thelowertheincidenceofVTE.MostpatientswithsymptomaticDVThaveproximalclots,andin40–50%ofcasesthisconditioniscomplicatedbyPE,oftenwithoutclinicalmanifestations.AsymptomaticPEiscommoninth

3、epostoperativephase,particularlyinpatientswithasymptomaticDVTwhoarenotgivenanythromboprophylaxisPEoccurs3–7daysaftertheonsetofDVTshockorhypotensionin5–10%ofcases,andinupto50%ofcaseswithoutshockbutwithlaboratorysignsofrightventriculardysfunction(RVD)and/orinjury,whichindicatesapoorerprognosis.comp

4、leteresolution;two-thirdsofallpatientswithoutanticoagulation,about50%,within3monthsanticoagulationtreatmentatleast3-12monthsofanticoagulationtreatmentPathophysiologyTheconsequencesofacutePEareprimarilyhaemodynamicandbecomeapparentwhen>30–50%ofthepulmonaryarterialbedisoccludedbythromboemboli.Large

5、and/ormultipleembolimightabruptlyincreasepulmonaryvascularresistancetoalevelofafterloadwhichcannotbematchedbytherightventricle(RV).Suddendeath:Electormechanicaldissociationsyncopeand/orsystemichypotensionPathophysiologyPatientssurviving:activatethesympatheticsystemrestingpulmonaryflow,leftventric

6、ularfillingandoutput,Togetherwithsystemicvasoconstriction,RVcoronaryperfusionandthefunctionoftheRVSecondaryhaemodynamicdestabilizationmayoccur,usuallywithinfirst24–48h,recurrentemboliordeteriorationofRVfunctionincreasedRVmyocardialoxygendemandanddecreasedRVcoronaryperfusionRespiratoryinsufficiencyi

7、nPEispredominantlyaconsequenceofhaemodynamicdisturbances.SeverityofpulmonaryembolismPrincipalmarkersusefulforriskstratificationinacutepulmonaryembolismTable4Riskstratificationaccordingtoexpectedpulmonaryembolism-related