肺血栓栓塞症的诊断与治疗指南草案

:,,100020()(pulmonarythromboembolism,PTE),,,,,,,,,,()(pulmonaryembolism,PE),,PTE,PTEPE,PE,PEPTE,,(pulmonaryinfarction,PI)PTE(deepvenousthrombosis,DVT)PTEDVTPTEDVT(venousthrom2boembolism,VTE),VTEPTEVTE,VTE,VCS(1),40VTE,,VTE,,,,VTE(2)1VTE3(thrombomodulin)(anticardiolipinantibodyssyndrome)20210ALeiden(C)SC:3VIE(),DVTPTEVTE,,,PTE,,(50%90%),,,,,,,;,,,;,,,;,,,95220015245ChinJTubercRespirDis,May2001,Vol24,No.52VTE/(50%75%)(Crohnsdisease)(50%100%)(12%)(5%35%)(5%)(15%30%)(3%9%)(30%60%)//,;,;,;;;,;,;,;;,(),,11:PTE,,,,PTE,(1)(80%90%):,;(2):(40%70%)(4%12%);(3)(11%20%):PTE;(4)(55%);(5)(11%30%):,;(6)(20%37%);(7)(10%18%)PI()30%21:(1)(70%):20/min,;(2)(30%40%);(3),;(4)(11%16%);(5)(43%):,(7%);(6)(12%);(7)(5%)()(18%51%),;(8)(24%30%);(9)(23%),P2A2,31:PTEPTE,DVT,DVTDVT41:,,2[P(A2a)O2]51:V12V4TST;SQT(S,Q/qT);;P;,,PTE61X:,:,;;;;;;;XPTE,PTE,X71:PTE,;();;;;,,PTE,06220015245ChinJTubercRespirDis,May2001,Vol24,No.5PTEPTE,,,,PTE,81D2(D2dimer):D2,D2PTE92%100%,,40%43%D2D2PTE,500g/L,PTE(ELISA),91/:PTE,,/,:(1):X;(2);(3):101CTCT:,PTEPTE,(),,(53%89%,78%100%);,,CTPTECTCT,111(MRI):,,,MRI,121:PTE98%,95%98%PTE,;,,PTE,PTE,011%115%,PTE,,131:(1):,95%DVT,(2)MRI:DVT90%100%,,MRIDVTMRI,(3)(IPG):DVT,(4):DVT,(5):DVT,,100%11PTE:(1),,(2),,(3)X,PTE(4)D2(ELISA),(5),,PTE,PTE21PTE:(1)/,,PTE96%,,;PTE;,,(2)CT/CTMRI,,CT(3)PTE,,,,31PTE:(1)PTE,XMRIDVT,16220015245ChinJTubercRespirDis,May2001,Vol24,No.5(2)PTEDVT,,PTE:(1)PTE,PTE:PTE(massive,PTE):,90mmHg(1mmHg=01133kPa),40mmHg,15minPTE(non2massive,PTE):PTEPTE,,PTE(submassivePTE)(2),,,PTEDVT,,(3)PTE,,,,,:,PTE,(1%5%),,DVT,:,;;:20mmHg,30mmHg::,,PTE11:PTE,,,PTE(ICU);,,,;;;21:,,(),,,,;,,,,500ml31:,,,,,PTEPTE,();PTE,,;14d,,PTE,,,,;:2;2;10d;15d;1;(180mmHg,110mmHg);;100109/L;;;;;PTE,,(UK)(SK)(rtPA),rtPA,UK:4400IU/kg,10min,2200IUkg-1h-112h;2h:20000IU/kg2hSK:250000IU,30min,100000IU/h24h,,rtPA:50l00mg2h26220015245ChinJTubercRespirDis,May2001,Vol24,No.52APTTAPTTAPTT(h)APTT:80IU/kg,18IUkg-1h-146APTT35s(112)80IU/kg,4IUkg-1h-16APTT3545s(112115)40IU/kg,2IUkg-1h-16APTT4670s(115213)6APTT7190s(213310)2IUkg-1h-16APTT90s(3)1h,3IUkg-1h-16UKSKrtPA,24h1(PT)(APTT),2,,41:PTEDVT,,()(warfarin),PTEDVTPTE,/APTTPT(,);,,PTE,():20005000IU80IU/kg,18IUkg-1h-124h46hAPTT,APTT,APTT115215,APTT1,(2)20005000IU,250IU/kg12h168hAPTTAPTTAPTT,,012014IU/ml()013016IU/ml(),APTT,(heparin2inducedthrombocytopenia,HIT),35d,710d14dHIT230%,100109/L,10dHITPTEDVT,,(LMWH):(anti2Xa),IU/kgmg/kg,),12,,,APTT,Xa(plasmaanti2xaactivity)alteparin:200anti2XaIU/kg,118000IUenoxaparin:1mg/kg,12h1,115mg/kg1,180mgnadroparin:86anti2XaIU/kg,12h1,10d;171anti2XaIU/kg,117100IUtinzaparin:175anti2XaIU/kg,1,PTEDVT,HITAPTT,57d7d,23d,,30ml/minXa5d,PTE,10d(lepirudin):36220015245ChinJTubercRespirDis,May2001,Vol24,No.5VTEHIT,,100109/L:/13d,310510mg/d,/45d,2d(INR)215(210310),PT115215,/,INRPT,INR,223,INR1,4INR136,,3;,6;VTE,,,12,36,INR310,K,,51:,:(1)PTE,,();(2);(3)61:,:PTE:;;71:,:,;PTE;PTE;;PTE;DVT,,;:1.,,2.:,3.:310510mg/d,INR,INR234.,5.,DVT2PTE,:(1):;(2):,(,,)(),DVT2PTE,DVT2PTE(:2001203209)(:)1999(50/)(15/)COPD(5/)(10/),199819992000(112/)(20/)1994(,5/),42,:100710,46220015245ChinJTubercRespirDis,May2001,Vol24,No.5