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Situations and Future Tactics of the Developments of PE and DVT in Southern China

为了解我国南方地区肺栓塞的现状,通过检索中国医院数字图书馆近9年(1999年～2008年)南方地区正式发表的与肺栓塞和深静脉血栓有关的论文共1288篇,进行了统计分析,发现:1、中国南方地区肺栓塞的发现数量逐年增加,且增幅明显;2、诊断水准达到一定程度的部分南方医院,诊断治疗肺栓塞的数量明显高于其他医院,并不比中国北方同类医院低;3、肺栓塞的漏诊、误诊现象依然普遍存在,提高认知和诊治水准仍然是今后工作的方向。

Surgical Treatment for Pulmonary Embolism Originated from Deep Venous Thrombosis

Prognostic Value of Troponin I, Brain Natriuretic Peptide and D-Dimer in Acute Pulmonary Embolism

Objective To investigate the prognostic value of troponin I ( cTNI) , brain natriuretic peptide ( BNP) and D-dimer in acute pulmonary embolism ( APE) .Methods The plasma levels of cTNI, BNP, and D-dimer were measured in 98 consecutive patients with APE at the time of admission. The relationship between these parameters and mortality were evaluated. Results APE was diagnosed in 98 consecutive patients during January 2009 to December 2010, in which 49 were males and 49 were females. 14 ( 14. 3% ) patients died at the end of follow-up. The patients with positive cTNI tests had more rapid heart rates, higher rate of syncope, cardiogenic shock and mortality than the patients with normal serumcTNI. However the age and blood pressure were lower in the patients with abnormal serum cTNI ( P lt; 0. 05) . A receiver-operating characteristic curve analysis identified BNP≥226. 5 ng/L was the best cut-off value ( AUC 0. 829, 95% CI 0. 715-0. 942) with the negative predictive value of 97. 1% for death. The mortality of the patients whose serum D-dimer level ranging from 500 to 2499 ng/mL, 2500 to 4999 ng/mL, and ≥5000 ng/mL was 7. 8% , 12% , and 41. 2% , respectively ( P = 0. 009) . Upon multivariate analysis, cardiogenic shock ( OR=2. 931, 95% CI 0. 828-12. 521, P =0.000) , cTNI≥0. 3 ng/mL ( OR=1. 441, 95% CI 0. 712-4. 098, P = 0. 0043) , BNP gt; 226. 5 ng/L ( OR = 1. 750, 95% CI 0. 690-6. 452, P = 0. 011) and D-dimer≥5000 ng/mL( OR = 1. 275, 95% CI 0. 762-2. 801, P = 0. 034) were independent predictors of death. Conclusions Combined monitoring of cTNI, BNP or D-dimer levels is helpful for prognosis prediction and treatment decision for APE patients.

Diagnostic value of MR for pulmonary embolism: a meta-analysis

ObjectiveTo systematic review the diagnostic value of magnetic resonance (MR) for pulmonary embolism (PE).MethodsWe electronically searched databases including EMbase, PubMed, The Cochrane Library, WanFang Data and CNKI from inception to November 2016, to collect the diagnostic studies about MR in the diagnosis of PE. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies, and then meta-analysis was conducted using Stata 12.0 software.ResultsA total of 14 studies involving 1 042 patients were included. The pooled Sen, Spe, +LR, –LR and DOR were 0.90 (95%CI 0.83 to 0.94), 0.95 (95%CI 0.90 to 0.98), 19.8 (95%CI 8.5 to 46.1), 0.10 (95%CI 0.06 to 0.18), 189 (95%CI 69 to 521), respectively. The AUC of SROC were 0.97 (95%CI 0.95 to 0.98).ConclusionMR has a good diagnosis value for PE which can be regarded as an effective and feasible method for suspected PE patients, especially for those who has contraindication of computed tomographic pulmonary angiography.

人工关节置换术后并发肺栓塞的护理

【摘要】 目的 通过分析2例关节置换术后肺栓塞发生的各种可能因素，进一步提高护理质量，降低其发生率，提高抢救成功率。 方法 收集2008年1月-2010年3月2例人工关节置换术并发肺栓塞的患者资料，从护理角度对肺栓塞的发生原因和护理措施进行分析。 结果 1例诊断及时，给予相应治疗及护理后痊愈出院，1例抢救无效死亡。 结论 尽早识别并正确处理肺栓塞是挽救生命的关键，肺栓塞发生后补充有效血容量、高流量吸氧、合理使用抗凝药物以及良好的功能锻炼是确保肺栓塞患者成功救治的保障。

Comparative Study of Surgical Treatments between Proximal and Distal Types of Chronic Thromboembolic Pulmonary Hypertension

Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ 　in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.

深低温下肺动脉取栓术的体外循环管理

目的 总结在深低温下行肺动脉取栓术体外循环管理的经验。方法 7例急性肺栓塞患者均在深低温低流量和深低温停循环下行肺动脉取栓术，并通过间断恢复血流，延迟复温，药物处理等技术，保护患者的心、脑、肺、肾等功能。结果 1例由于体外循环时间较长(335分钟)，且心功能较差，静脉血氧饱和度不能有效的维持，脱机困难，使用了体外膜肺支持，最终因多器官功能衰竭而死亡。1例因肺水肿施行二次肺动脉环缩术后，肺水肿明显改善；其他患者术后恢复顺利。结论 在深低温体外循环下行肺动脉取栓术是安全有效的方法。

肝后下腔静脉狭窄导致术中呼气末二氧化碳降低一例

Protocol of Systematic Review of Thrombolytic Therapy for Pulmonary Embolism

To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.

Analyses of Paradoxical Embolism Originated from Pulmonary Embolism:Chinese LiteratureReview and A Case Report

Objective To improve the knowledge of paradoxical embolism originated from pulmonary embolism. Methods The medical literature about pulmonary embolism complicated with paradoxical embolism from 1998 to 2011 was searched from “Wanfang medical literature database”. Meanwhile 1 case diagnosed in Central Hospital of Dazhou City was reported. Then the clinical characteristics were summarized. Results 51 cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, aged from23 to 76 years old. There were 27 males and 23 females, and sex was unknown in 1 case. In all cases, the cerebral embolism occurred in 30 cases( 58. 8% ) , lower limb artery embolism in 14 cases( 27. 4% ) , kidney artery embolism in 6 cases( 11. 8% ) , patent foramen ovale with straddling thrombus in 4 cases( 8% ) ,multiple embolismin 8 cases( 15. 7% ) , heart ventricle with straddling thrombus in 1 case ( 1. 96% ) , coronary artery embolism in 1 case( 1. 96% ) , aorta embolism in 1 case( 1. 96% ) , and spleen embolism in 1 case ( 1. 96% ) . There were 35 patients ( 68. 8% ) with patent foramen ovale and 7 cases ( 13. 7% ) died. Conclusions Paradoxical embolism waranted more awareness in the cases of pulmonary embolismand/ or venous thromboembolism and aggressive screening might avoid misdiagnosis.