![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=1738976577-awbJL8T49APcMXui2iDMTpk7Uzf6T6Ve-0-32709270fd77dcc7ccee84f311ccd339)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.1_1_59982.jpg?sign=1738976577-vtsebp1RIKCimsiP3e3jlHgvqeOJ8wTe-0-4e6927cb37aa9aaa5a19917f1fdad12c)
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=1738976577-6DwxpwxWpGJ34i0nERZFCj48ibjGcY1q-0-1b59de84778c80461b57590b9171b288)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.2_1_59984.jpg?sign=1738976577-p2bJCeJFbssaxkkUW3aewwL7ddQoyDd8-0-058574daa67d0196962d68633fb21b5c)
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=1738976577-vuLbtkLcxxnhfIOIlDz9wpDfARV7VAbI-0-18ab19c8f8a490e87272c9cddc96a6bf)
表15.4 紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.4_59662.jpg?sign=1738976577-9HkNZ3JwmfRJC79LzOQHaU4yLQPyZN4U-0-f0979692ba2c2a95bc0f6d945046ab25)
表15.5 紧急处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.5_13076.jpg?sign=1738976577-hCJ4Ke8pyggYZHK60jBEnLObyRqHJE5y-0-aa9d63511f89012c2b0119a7be23bff5)
表15.6 进一步治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.6_13083.jpg?sign=1738976577-eHwzw5fFow6UhghmLFpgFMYLuQJcfKTi-0-4b09cc1e4f2e3d98dc62090c71ffcfab)
表15.7 溶栓治疗的指征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_13090.jpg?sign=1738976577-0VohxWsioqNyDDUZ0ABiUkHTJEwdI5Py-0-93385fe8c25a8734f5bec5effb57d14f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_1_13134.jpg?sign=1738976577-8uudUucUc7Ps37OW0IzWJwwGmQWeFYzA-0-bd88f6bcbb39a6058abd8dcb23f455c8)