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肺栓塞

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维基百科,自由的百科全书
Pulmonary embolism
肺部的電腦斷層掃描顯示出肺栓塞(箭頭所指處)
症状Hampton hump[*]Westermark sign[*]
类型pulmonary artery disease[*]疾病
分类和外部资源
醫學專科心臟內科、​血液學、​胸腔醫學
ICD-11BB00
ICD-10I26
ICD-9-CM415.1
DiseasesDB10956
MedlinePlus000132
eMedicinemed/1958 emerg/490 radio/582
MeSHD011655
[编辑此条目的维基数据]

肺栓塞[1]pulmonary embolism,PE)是体循环的各种栓子(内源性或外源性栓子)阻塞肺动脉或其分支,从而引起肺循环呼吸功能障碍的一组疾病或临床综合征肺血栓栓塞[2][3](pulmonary thromboembolism,PTE)为最常见的肺栓塞,其为来自静脉系统或右心的血栓阻塞肺动脉或其分支所致的疾病,全名肺动脉血栓栓塞[4][5](pulmonary artery thromboembolism)。

肺栓塞一般指急性肺動脈栓塞[6],少數為慢性肺動脈栓塞[7]。肺栓塞的症狀有呼吸困難、吸氣時胸痛,以及咳血等等[8],也可能會出現下肢靜脈血栓的症狀,使下肢產生、腫、痛等情形[8]。肺栓塞的徵狀有氧氣濃度降低、呼吸急促心跳加速,以及些微發燒[9]。嚴重的病例可能會出現昏厥休克,甚至猝死[10]

肺栓塞時常肇因於下肢血栓行至肺部[1]。而血栓形成的風險因子有罹患癌症或某些遺傳疾病、臥床英语Bed rest過久、吸菸中風、使用激素替代療法懷孕、患有肥胖、曾接受過某些手術[11]。有些案例的肺栓塞是由氣泡脂肪栓塞羊水所造成的[12][13]。診斷時需要結合臨床症狀及檢驗結果來做確診[14]。如果風險較低,可以檢測D-dimer英语D-dimer來排除可能的情形[14]肺血管電腦斷層攝影英语CT pulmonary angiography肺臟血流灌注掃描英语lung ventilation/perfusion scan,或照腿部超音波等等[14]深靜脈栓塞與肺栓塞可以合稱為靜脈血栓栓塞英语venous thromboembolism(venous thromboembolism,VTE)[15]

預防肺栓塞發生有以下方法,如術後盡快活動、久坐時進行腿部運動,在某些手術後使用抗凝劑[16]。治療時需搭配使用抗凝劑,像是肝素華法林或是某種直接口服抗凝血劑(簡稱為 DOACs)[17]等,以上皆建議至少使用三個月[17]。嚴重的病例可能需要血栓溶解英语thrombolysis用藥,例如經由靜脈或插導管給抗凝血藥組織纖維溶酶原活化劑英语Tissue plasminogen activator(簡稱為 tPA)或是接受手術(如 肺栓塞取栓術英语Pulmonary thrombectomy[18] 。如果病患狀況不適合使用抗凝劑,可考慮使用暫時性下腔靜脈過濾器英语vena cava filter[18]

歐洲,一年約有 43 萬人罹患肺栓塞[19],在美國,一年約有 30 到 60 萬名病例[1][20],其中約有 5 萬[20]到 20 萬起致死案例[21],男女患病比例幾乎均等[11]。隨著年齡增加,罹患此症越見普遍[11]


參見

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參考資料

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  1. ^ 1.0 1.1 1.2 What Is Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于12 March 2016). 
  2. ^ Goggs, Robert, et al. "Pulmonary thromboembolism." Journal of Veterinary Emergency and Critical Care 19.1 (2009): 30-52.
  3. ^ Sasahara, Arthur A., et al. "Pulmonary thromboembolism: diagnosis and treatment." Jama 249.21 (1983): 2945-2950.
  4. ^ Rittoo, Dylmitr, and George R. Sutherland. "Acute pulmonary artery thromboembolism treated with thrombolysis: diagnostic and monitoring uses of transoesophageal echocardiography." Heart 69.5 (1993): 457-459.
  5. ^ CIVELEK, A. CAHID M.D.,*; WANG, ERIC A. M.D.,*; BARR, LINDA M.D.,†; URBAN, BRUCE A. M.D.*; ENG, JOHN M.D.*. Asymptomatic Large Main Pulmonary Artery Thromboembolism with a Low-Probability Ventilation–Perfusion Lung Scan. Clin Nuclear Med 26(3):p 216-220, March 2001.
  6. ^ Agnelli G, Becattini C. Acute pulmonary embolism[J]. New England Journal of Medicine, 2010, 363(3): 266-274.
  7. ^ Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther. 2018;8(3):253-271. doi:10.21037/cdt.2018.01.09
  8. ^ 8.0 8.1 What Are the Signs and Symptoms of Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于9 March 2016). 
  9. ^ Tintinalli JE. Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) 7. New York: McGraw-Hill Companies. 2010: 432. ISBN 978-0-07-148480-0. 
  10. ^ Goldhaber SZ. Pulmonary thromboembolism. Kasper DL, Braunwald E, Fauci AS, et al (编). Harrison's Principles of Internal Medicine 16th. New York, NY: McGraw-Hill. 2005: 1561–65. ISBN 978-0-07-139140-5. 
  11. ^ 11.0 11.1 11.2 Who Is at Risk for Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于15 February 2016). 
  12. ^ What Causes Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于7 April 2016). 
  13. ^ Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M. Amniotic fluid embolism: review. Current Pharmaceutical Biotechnology. 2014, 14 (14): 1163–7. PMID 24804726. doi:10.2174/1389201015666140430161404. 
  14. ^ 14.0 14.1 14.2 How Is Pulmonary Embolism Diagnosed?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于7 April 2016). 
  15. ^ Other Names for Pulmonary Embolism. July 1, 2011 [12 March 2016]. (原始内容存档于16 March 2016). 
  16. ^ How Can Pulmonary Embolism Be Prevented?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于7 April 2016). 
  17. ^ 17.0 17.1 Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. February 2016, 149 (2): 315–352. PMID 26867832. doi:10.1016/j.chest.2015.11.026. 
  18. ^ 18.0 18.1 How Is Pulmonary Embolism Treated?. NHLBI. July 1, 2011 [12 March 2016]. (原始内容存档于9 March 2016). 
  19. ^ Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arteriosclerosis, Thrombosis, and Vascular Biology. November 2014, 34 (11): 2363–71. PMID 25304324. doi:10.1161/atvbaha.114.304488. 
  20. ^ 20.0 20.1 Rahimtoola A, Bergin JD. Acute pulmonary embolism: an update on diagnosis and management. Current Problems in Cardiology. February 2005, 30 (2): 61–114. PMID 15650680. doi:10.1016/j.cpcardiol.2004.06.001. 
  21. ^ Kumar V, Abbas AK, Fausto N, Mitchell RN. Basic Pathology. New Delhi: Elsevier. 2010: 98. ISBN 978-81-312-1036-9. 
醫療科學 - 醫學 - 血液學 - 編輯
骨髓惡性腫瘤白血球
淋巴系統: 淋巴型白血病 (急性、 慢性) | 淋巴瘤 (何杰金氏病、 非何杰金氏淋巴瘤) | 淋巴增殖性病變 | 骨髓癌 (多發性骨髓癌、 質漿細胞瘤
骨髓: 骨髓性白血病 (急性、 慢性) | 骨髓增殖性疾病 (原發性血小板增多症、 紅血球增多症) | 骨髓成形不良症候群 | 骨髓纖維化 | 嗜中性白血球過低症
紅血球
贫血 | 血色病 | 鐮刀型紅血球疾病 | 地中海貧血 | 溶血反應 | 再生不良性貧血 | 蠶豆症 | 遺傳性球形紅細胞增多症 | 遺傳性橢圓形紅血球增多症 | 其他血紅蛋白病
凝血因子血小板
血栓形成 | 深靜脈血栓形成 | 肺栓塞 | 血友病 | 自發性血小板缺乏紫斑症 | 血栓性血小板缺乏紫斑症 | 彌散性血管內凝血