D-二聚体正常肺栓塞病例的诊断与治疗分析1例
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摘要
患者为51岁女性,因"反复抽搐1月"入院,查体未见明显神经系统阳性体征,多次检测D-二聚体均在正常范围,脑部CT、脑电图等检查提示无明显异常。患者入院时出现持续低氧血症,遂行肺动脉灌注CT成像检查,结果示双侧肺动脉主干远端及各主要分支见血管充盈缺损,部分管腔狭窄闭塞,双侧肺动脉小分支可见广泛类似充盈缺损,最终确诊为肺栓塞。患者经华法林抗凝治疗后病情稳定。
The patient was a 51-year-old female. She was admitted to the hospital because of "repetitive convulsions for 1 month". No significant neurological positive signs were found in the examination. D-dimer was in the normal range in several times of detection. Brain CT andelectroencephalograph showed no obvious abnormality. Sustained hypoxemia occurred on admission, and CT imaging of pulmonary artery perfusion was performed. In the CT images bilateral distal main pulmonary arteries and their main branches showed vessel filling defect, partial lumen stenosis and occlusion, and bilateral small branches of pulmonary arteries showed extensive similar filling defect. Finally the patient was diagnosed with pulmonary embolism, whose condition was stable after anticoagulation therapy with warfarin.
The patient was a 51-year-old female. She was admitted to the hospital because of "repetitive convulsions for 1 month". No significant neurological positive signs were found in the examination. D-dimer was in the normal range in several times of detection. Brain CT andelectroencephalograph showed no obvious abnormality. Sustained hypoxemia occurred on admission, and CT imaging of pulmonary artery perfusion was performed. In the CT images bilateral distal main pulmonary arteries and their main branches showed vessel filling defect, partial lumen stenosis and occlusion, and bilateral small branches of pulmonary arteries showed extensive similar filling defect. Finally the patient was diagnosed with pulmonary embolism, whose condition was stable after anticoagulation therapy with warfarin.
引文
[1]董怀平,李庆敏.血浆D-二聚体的测定在排除肺栓塞诊断中的临床意义[J].实用医技杂志,2006,13(16):2779-2781.
[2]梅玲.检测D-二聚体在肺栓塞诊断中的临床意义[J].中国实用医药,2007,2(34):15-16.
[3]何丽娜,李宾公,郑泽琪,等.136例院内肺栓塞患者情况分析[J].江西医药,2012,47(5):412-414.
[4]郎景和,王辰,瞿红,等.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志,2017,52(10):649-653.
[5]张心怡,况九龙.100例不典型急性肺栓塞临床诊治体会[J].江西医药,2013,48(5):417-419.
[6]曹艳霞,吴颂红,王彬生,等.肺栓塞与D-二聚体相关性及影响因素[J].医学研究与教育,2012,29(6):10-12.
[7]陈菲,郑亚安,王真.常规检查手段对肺栓塞辅助诊断价值的比较分析[J].临床荟萃,2009,24(4):304-306.
[8]延景袆.急性肺栓塞一例附文献复习[J].实用心脑肺血管病杂志,2008,16(5):64-65.
[9]张艳芳,姚建聪,杨利荣,等.急性大面积肺栓塞静脉溶栓治疗成功1例[J].中国危重病急救医学,2011,23(9):572-573.
[10]中华医学会心血管病分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识(2015)[J].中华心血管病杂志,2016,44(3):197-211.
[2]梅玲.检测D-二聚体在肺栓塞诊断中的临床意义[J].中国实用医药,2007,2(34):15-16.
[3]何丽娜,李宾公,郑泽琪,等.136例院内肺栓塞患者情况分析[J].江西医药,2012,47(5):412-414.
[4]郎景和,王辰,瞿红,等.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志,2017,52(10):649-653.
[5]张心怡,况九龙.100例不典型急性肺栓塞临床诊治体会[J].江西医药,2013,48(5):417-419.
[6]曹艳霞,吴颂红,王彬生,等.肺栓塞与D-二聚体相关性及影响因素[J].医学研究与教育,2012,29(6):10-12.
[7]陈菲,郑亚安,王真.常规检查手段对肺栓塞辅助诊断价值的比较分析[J].临床荟萃,2009,24(4):304-306.
[8]延景袆.急性肺栓塞一例附文献复习[J].实用心脑肺血管病杂志,2008,16(5):64-65.
[9]张艳芳,姚建聪,杨利荣,等.急性大面积肺栓塞静脉溶栓治疗成功1例[J].中国危重病急救医学,2011,23(9):572-573.
[10]中华医学会心血管病分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识(2015)[J].中华心血管病杂志,2016,44(3):197-211.