![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
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15. 肺 栓 塞
概 述
肺栓塞(pulmonary embolism,PE)是以各种栓子阻塞肺动脉系统为发病原因的一组疾病的总称,包括肺血栓栓塞症(pulmonary thromboembolism,PTE)、脂肪栓塞综合征、羊水栓塞和空气栓塞等。PTE为PE的最常见类型,指静脉系统或者右心的血栓阻塞肺动脉或其分支所致的疾病,以肺循环或肺功能障碍为主要表现和病理生理特征。以下是肺栓塞诊治的临床路径。
表15.1 肺栓塞的主要临床表现
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.1_59981.jpg?sign=1739513778-rSvXwL4fUZSzIVlEUjGajJJaV0Ii3bOp-0-653b536cb09bec14b7f5e1611607b74a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.1_1_59982.jpg?sign=1739513778-l7bGihYjzahEr50iZJg4PKwWs7c0avWB-0-30eb4110e84da10cdecf8defa16cf8d7)
表15.2 评价肺栓塞的可能性——Wells及改良的Geneva评分
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.2_59983.jpg?sign=1739513778-2S7zB7cv5NVavPxmpaNwFJVGv4dOV0iu-0-b287b9c69f54020495127395138c612b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.2_1_59984.jpg?sign=1739513778-lRWoCCUipne9YjOgHEWmqk3foOCIGKOA-0-cfd6c2fecfa98ec6ceb7798518bac656)
表15.3 急性肺动脉主干栓塞的心脏超声表现
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.3_13053.jpg?sign=1739513778-hrOdVvaHHMTqvFkWGj5HQhjT4OvgsLx8-0-7fa082a2b338e049fdb73f6dc97d40c0)
表15.4 紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.4_59662.jpg?sign=1739513778-CReTWxcL423tFThbJGqWpSMfG1HNMx55-0-64bf94e9523e9509d3ff149d417e8bbd)
表15.5 紧急处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.5_13076.jpg?sign=1739513778-RAR8kKiZ9KPbhAs5r1kJKH7EPdG5vEOY-0-5a29439595c1264c47116756707865ac)
表15.6 进一步治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.6_13083.jpg?sign=1739513778-WjHcJRKQoAyv8pzS1YwLmWyVe6vwMOKy-0-296c70e21b986d107cfa0c2f30820e0f)
表15.7 溶栓治疗的指征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_13090.jpg?sign=1739513778-jbo4VG8AxNmXvNtX5AVcLMi01FDtTwAr-0-64e3bc344e29616e4a8cefcd95262338)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_1_13134.jpg?sign=1739513778-wxpG2j6tZhBrE7oRpJoNfKIKT4Oh5JsH-0-f45833f239c18f4be24812249fff00e7)