Pulmonary embolism is very urgent in treatment

Pulmonary embolism is very urgent in treatment
Pulmonary embolism is a common cardiovascular vessel disease The leaking of pulmonary embolism is examined and the misdiagnosing rate is up to 70% The clinical manifestation of pulmonary embolism is varied, widely different The artery radiography of lung is the most accurate and most reliable pulmonary embolism diagnostic method It is modern and therapeutic threads of pulmonary embolism to be anticoagulatory and dissolve the bolt treatment 80% of the pulmonary embolism patients have already had deep phlebothrombosis of lower extremities while going to a doctor The shocking data show: Pulmonary embolism (PE) It is a common cardiovascular vessel disease, especially this disease is more incident in the impatient. It is estimated the intersection of U.S.A. and every year about 600,000 the intersection of example and above the intersection of PE and patient, cause 5- 20 the intersection of patient and death Wan, second only to malignant tumour and coronary heart disease. On clinic, not going on, mortality of PE patient that has treated has been 30%, and probably only 2.5% of mortality of patient accepting modern treatment in time. The death that acute PE causes is often calculated with minute, in all PE death cases, 90% happen in getting up after being ill for 2 hours. Died in all PE in the case, only 1/3 are diagnosed before the death correctly, only 6.5% got the correct treatment. In our country, because the population base is enormous, the morbidity of thrombus diseases such as the deep phlebothrombosis of lower extremities,etc. is relatively high, and anticoagulation not adopted resist bolt intensity often enough, to have illness coming on, count, take far higher than U.S.A. absolutely PE at present. So, must pay attention to the making a diagnosis and giving treatment of PE extraordinarily. The clinical manifestation of PE is various, lacks the specificity, some clinicians lack due vigilance to this disease, in addition rely on the textbook excessively in the course of making a diagnosis and giving treatment " The model behaves " ,But rare again in practice " The peak points to the Tenneco shade of the lung door " Wait, lead to the fact PE makes a diagnosis and gives treatment there are mistaken ideas in the course at present. The lung tissue has double blood supplt, there is strong compensation ability. Under the originally normal situation of heart and lungs, area of section of blood vessel bed of the lung stops up above 50% to just begin to present symptom in machinery, until machinery stop up, 70% can appear serious the intersection of lung and the intersection of artery and high pressure and shock while being above. So, the manifestation of PE is varied: Symptom that the lighter can not be obvious, this often causes the mistaken diagnosis of the patient; The serious one condition is critical, can be shown as and fainted or died suddenly, the ones that cause to this disease leak and examining. In fact, 80% more than the intersection of PE and patient lack typical the intersection of S Q T and the intersection of heart and electric chart now, so-called the intersection of chest and block " whether peak point to the intersection of lung and Tenneco shade of door " More rare, and " round or flaky shade of spot " relatively seen more And often sum " Acute pneumonia " Link together, when the patient toss about in bed in the emergency ward - ward - CT room, nuclear medicine dept. or catheter room, the tragedy may already take place. In all the intersection of PE and the intersection of death and case, 90% take place in getting up 2 hour after being ill, and person who review diagnosis belong to coronary artery cause of the death their often convulsion, coronary artery acute to hard to get. The above-mentioned situations may be to cause the hospitals at all levels of our country to diagnose very rare reason to acute PE for a long time. The manifestation is various The main manifestation of setting up the trap PE is as follows, (1)Have difficulty in breathing: 85% more than patient appear take place suddenly have difficulty in breathing. The lighter breathes hard after presenting the popping excessively taking a breath and activity, the serious one presents continuation and has difficulty in breathing, breathe light fast, can be up to every minute 40- 50 times. (2)The chest aches: See to more than 80% of the patients. There are two kinds of situations: Majority ache for pleura chest, show as, breathe, chest ache aggravate cough, brief on vascular thromboembolism of the lung or lung infarction around the small one; Minority are angina pectoris, the asymmetry presses the sense, can radiate to shoulder blade and shank behind showing as the brestbone, brief on the trunk thromboembolism causes the lung artery to be acute and expands and coronary artery is ischemic. (3)Spit blood: See on 40% about patient, scarlet, turn into getting dark red after the several days, brief lung on infarction. (4)Faint: See the patient about 15%, result from the reason that it causes the brain to be ischemic that heart displacement is reduced sharply, brief on acute thromboembolism of the trunk. (5)Other: Because of having difficulty in breathing, excessively taking a breath and it cause the patient to have the fidgets, terrified, etc that the chest aches etc.. The clinical manifestation of PE is widely different, but some common diseases such as " pneumonia " of blood vessel and respiratory system diligently , " acute coronary artery and syndrome " Wait for going on to explain, it is " trap " existing in the course of clinical diagnosis . Auxiliary examination Help you to diagnose (1)The analysis of vim and vigour: PaO2 drops, (A-a) DO2 increases, PaCO2 is normal or reduces, but the partial pressure of oxygen of more than 20% of the patients can be totally normal, hypoxemia disease is not a prerequisite of dynamics unstable PE of blood flow. (2)Electrocardiogram: Electrocardiogram change into, pass at the PE, it is obvious: Lean towards by lung the intersection of P and wave, electric the intersection of axle and right, right bunch prop up, block and section ST change specificity and the intersection of V1-4T and wave invert with S Q T,etc. changing deeply. S Q T rarely seen on about 20% patient, so have S Q T appear at the electrocardiogram, must not get rid of the diagnosis of PE. (3)The X-ray behaves: Depend on the position of thromboembolism and size of the embolus, can be shown as: Bronchitis kind change, lung blood flow volume reduce, thromboembolism the intersection of position and lung lamination reduce and the luminosity increases completely, the lung lamination of both sides is asymmetric, the thorax accumulates non- specific changes such as the liquid,etc.. So-called " Tenneco shade of the lung door that the bottom links with pleura, the peak points to " I haven't seen you for a long time. Can be seen the intersection of lung and the intersection of artery and section expand under the right, lung artery section outstanding, lung artery beat, strengthen, the right ventricle is expanded, superior vena cava and azygos vein are increased widely etc. and behaved. But some patient chest slices can be totally normal. (4)The nuclide scans: Think lung keep in touch with - pour into, scan, have the sure one to be false and positive, combine clinical manifestation at present, there is higher diagnosis value on PE. Keeping in touch with and pouring into normally can get rid of PE. (5)The interesting Fig. of the supersound: Can observe the left and right ventricle function and estimate and examine the artery pressure of lung real-timely and dynamically, thromboembolism revealing the lung artery backbone and about in the branch directly, can also detect the deep intravenous thrombus of bigger lower extremities. So, the interesting picture of the supersound is the most important, most practical diagnosis and helping to treat the tool of decision under an emergency call situation by the real-time, dynamic bed. (6)CT: It is one of the diagnostic methods with very high sensitiveness that CT strengthens and scans. (7)The artery radiography of lung: Not only the most accurate and most reliable PE diagnostic method, but also can mash, suck the enormous embolus out of directly through the conduit, or pour into and dissolve the bolt medicine to treat through the conduit. (8)Check in the laboratory: PE patient has leucocyte increasing slightly, erythrocyte sedimentation rate to increase fast,etc.. Can simplify the diagnosis course of PE, if D - gather the body two times while carrying on D - two detection which gather the body

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