Pulmonary embolism and pulmonary infarction

Overview of acute pulmonary heart disease was mainly due to venous system or from the right ventricle into the pulmonary emboli, cause pulmonary trunk or branches of the extensive embolization, with extensive pulmonary artery spasm, pulmonary circulation blocked, pulmonary artery pressure arising from the dramatic increase in right ventricular expansion and right heart failure. Cause pathogenesis bed-and long-term oral contraceptive drugs; Thrombophlebitis. heart disease (RHD especially atrial fibrillation and heart failure with bacterial endocarditis), varices; severe trauma, bone fractures; surgery, pregnancy or childbirth, intravenous cannulation; obesity, cancer and other risk factors and underlying diseases. A clinical manifestations suddenly breathing difficulties, severe chest pain, hemoptysis, or syncope, and other symptoms. 2, respiratory and cardiac rhythm faster, pulmonary rales, pulmonary valve second heart sound hyperthyroidism. Chest showing Patchy or pulmonary wedge-shaped shadow, discoid atelectasis side of the diaphragm elevation, pulmonary artery thickening and helical reduction. 3, ECG and cardiac vector is right heart involvement performance : severe clockwise to the transfer, pulmonary p-wave, right-axis deviation, and other changes. 4, blood gas analysis PaO2 "10,64 mmHg, alveolar-arterial oxygen partial pressure and poor has increased. dead space / tidal volume values (VD / VT) "40%; Blood lactate dehydrogenase "450U. aspartate aminotransferase (AST) and creatine phosphokinase (CPK) normal hemoglobin increased. 5, lung ventilation / perfusion (V / Q) scan showed va / QoS (n normal, no perfusion q). 6, pulmonary angiography, X-ray findings of pulmonary intravascular pulmonary defects or stop a phenomenon. The diagnosis of pulmonary embolism is the most accurate and reliable measures. Diagnosis except cause similar short breath, chest pain, hemoptysis symptoms of the disease, such as acute myocardial infarction, aortic dissection, pneumothorax pneumonia, esophageal rupture, mediastinal emphysema. Experimental an inspection, a clotting factor, that the clotting time, fibrinogen degradation products, soluble fiber protein complexes, hemorrheology and blood gas analysis. 2, pulmonary function tests, including pulmonary and arterial oxygen difference, ventilation and perfusion ratio and dead space / tidal volume values. 3, electrocardiogram, cardiac vector, echocardiography examination. 4, chest X-ray, CT if conditions and MRI. 5, lung ventilation / perfusion imaging, pulmonary angiography or digital subtraction angiography. 6, such as suspicious deep vein thrombosis, viable limb venous angiography, Doppler ultrasound vascular screening. For a general treatment : absolute bed rest, oxygen, spasm and pain relief, use of aminophylline, atropine, not yet. papaverine to disarm bronchial and vascular spasm and pain; as a result of heart failure or shock can be used, as appropriate, Mao spent C glycosides, Dopamine, isoproterenol and low molecular weight dextran, and so on. 2, anticoagulant therapy : (1) heparin therapy : (2) of vitamin k Ji-agent : If the new anticoagulant tablets; Or dicoumarol. (3) thrombolytic therapy : unless contraindications to thrombolysis, the incidence hours for the application of thrombolytic therapy. Such as streptokinase, urokinase and recombinant tissue plasminogen. 3, surgical treatment : (a) pulmonary embolism embolectomy : (2) block the inferior vena cava : (3) suction catheter for venous thrombosis