急性肺栓塞诊治与护理课件

急性肺栓塞Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性肺栓塞1肺栓塞(pulmonary基本概念embolism,PE是以各种栓子堵塞肺动脉系统为其发病原因的综合征血栓、脂肪、羊水、空气栓塞等肺血栓栓塞症(pulmonarythromboembolism,PTE)是指来源于静脉系统或右心血栓堵塞肺动脉或其分核Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺栓塞(pulmonary2肺梗死(pulmonaryinfarction,P〕肺栓塞发生后引起肺组织出血或坏死发生率不到10%③肺组织有四重血液供应肺动脉、支气管动脉、肺循环和支气管血管之间交通、肺泡氧弥散。Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺梗死(pulmonary3PredisposingFactorsforPulmonaryEmbolism静脉血栓栓易患因素易患因素强易患因素中等易患因素髖或膝关置换膝关节镜手术普外科大手术中心静脉置管大创伤化疗脊髓损伤慢性心衰或呼衰弱易患因素激素替代治疗卧床>3天恶性肿瘤久坐不动口服避孕药治疗如长途车)中风发作年龄增长如胆囊切除术既往下肢静脉血栓〓腹腔镜手术怀孕/产后Trauma肥胖血栓形成倾向怀孕产前静脉曲张心象Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLPredisposingFactorsforPulmo4肺栓塞引起的血流动力学改变感受器使肺血管收缩血栓堵塞肺动脉左室舒张期容量下降L肌缺血右室扩张L搏出量下降图6-3肺栓塞引起的血流动力学改变血栓机械性堵塞肺动脉,刺激神经体液因素及压力感受器的反射作用,肺动脉痉挛,肺动脉压升高右心室负荷增加,右心室扩张,室间隔向左移位。神经体液因素的作用,使支气管痉各种因素的作用使通气血流比例失衡,出现低氧血症和急性肺心病表现,心搏出量降低,重症出现休克或猝死Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺栓塞引起的血流动力学改变5临床表现呼吸困难及气促胸痛咯血晕厥烦频躁不安、惊恐濒死感心悸猝死Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL临床表现6临床表现体征:心动过速血压变化,重者血压下降、休克颈静脉充盈怒张或异常搏动P2亢进,三尖瓣区收缩期杂音Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL临床表现7DVT临床表现患肢肿胀、周径增粗、疼痛或压痛浅静脉扩张皮肤色素沉着Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLDVT临床表现8实验室检查D-二聚体(D-Dimer)检查交联纤维蛋白(Fb)特异的降解产物,它的生成或增高反映了凝血和纤溶系统的激活③放射核紊肺通气/灌注扫描(ECT通气和灌注均正常,可除外肺栓塞通气正常或增加,伴肺段或肺叶的灌注显像缺损,可确诊③肺的通气及灌注显像均有缺损CT肺动脉造影③肺动脉造影“金标准”,有创伤,检查的死亡率约1%心电图检查主要表现为窦速、肺性P波、重者出现肺心病SIQⅢTⅢ,部分可出现不完全性右束支传导阻滞Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL实验室检查9EGG示SIQlITlllRBBB个个M下k急性肺栓塞在心电图上可能出现的特异性表现为:深的S1,明显的Q1和T倒置;Ⅱ导联的ST段压低(1导联有时也会出现);T双向或倒置;右束支传导阻滞心动过速通气扫描正常右肺灌注扫描缺损。左肺的10栓子没有见到Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLEGG示SIQlITlllRBBB10急性肺栓塞诊治与护理课件11急性肺栓塞诊治与护理课件12急性肺栓塞诊治与护理课件13急性肺栓塞诊治与护理课件14急性肺栓塞诊治与护理课件15急性肺栓塞诊治与护理课件16急性肺栓塞诊治与护理课件17急性肺栓塞诊治与护理课件18急性肺栓塞诊治与护理课件19急性肺栓塞诊治与护理课件20急性肺栓塞诊治与护理课件21急性肺栓塞诊治与护理课件22急性肺栓塞诊治与护理课件23急性肺栓塞诊治与护理课件24急性肺栓塞诊治与护理课件25急性肺栓塞诊治与护理课件26急性肺栓塞诊治与护理课件27急性肺栓塞诊治与护理课件28急性肺栓塞Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性肺栓塞29肺栓塞(pulmonary基本概念embolism,PE是以各种栓子堵塞肺动脉系统为其发病原因的综合征血栓、脂肪、羊水、空气栓塞等肺血栓栓塞症(pulmonarythromboembolism,PTE)是指来源于静脉系统或右心血栓堵塞肺动脉或其分核Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺栓塞(pulmonary30肺梗死(pulmonaryinfarction,P〕肺栓塞发生后引起肺组织出血或坏死发生率不到10%③肺组织有四重血液供应肺动脉、支气管动脉、肺循环和支气管血管之间交通、肺泡氧弥散。Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺梗死(pulmonary31PredisposingFactorsforPulmonaryEmbolism静脉血栓栓易患因素易患因素强易患因素中等易患因素髖或膝关置换膝关节镜手术普外科大手术中心静脉置管大创伤化疗脊髓损伤慢性心衰或呼衰弱易患因素激素替代治疗卧床>3天恶性肿瘤久坐不动口服避孕药治疗如长途车)中风发作年龄增长如胆囊切除术既往下肢静脉血栓〓腹腔镜手术怀孕/产后Trauma肥胖血栓形成倾向怀孕产前静脉曲张心象Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLPredisposingFactorsforPulmo32肺栓塞引起的血流动力学改变感受器使肺血管收缩血栓堵塞肺动脉左室舒张期容量下降L肌缺血右室扩张L搏出量下降图6-3肺栓塞引起的血流动力学改变血栓机械性堵塞肺动脉,刺激神经体液因素及压力感受器的反射作用,肺动脉痉挛,肺动脉压升高右心室负荷增加,右心室扩张,室间隔向左移位。神经体液因素的作用,使支气管痉各种因素的作用使通气血流比例失衡,出现低氧血症和急性肺心病表现,心搏出量降低,重症出现休克或猝死Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺栓塞引起的血流动力学改变33临床表现呼吸困难及气促胸痛咯血晕厥烦频躁不安、惊恐濒死感心悸猝死Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL临床表现34临床表现体征:心动过速血压变化,重者血压下降、休克颈静脉充盈怒张或异常搏动P2亢进,三尖瓣区收缩期杂音Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL临床表现35DVT临床表现患肢肿胀、周径增粗、疼痛或压痛浅静脉扩张皮肤色素沉着Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLDVT临床表现36实验室检查D-二聚体(D-Dimer)检查交联纤维蛋白(Fb)特异的降解产物,它的生成或增高反映了凝血和纤溶系统的激活③放射核紊肺通气/灌注扫描(ECT通气和灌注均正常,可除外肺栓塞通气正常或增加,伴肺段或肺叶的灌注显像缺损,可确诊③肺的通气及灌注显像均有缺损CT肺动脉造影③肺动脉造影“金标准”,有创伤,检查的死亡率约1%心电图检查主要表现为窦速、肺性P波、重者出现肺心病SIQⅢTⅢ,部分可出现不完全性右束支传导阻滞Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyrigh