![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=1739250753-jkKdhquOJASDUq72xghHnyrKtUk6XsIg-0-ab91277ceaf383a64481ba6f0d7c99f3)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.1_1_59982.jpg?sign=1739250753-WD6nRkbKr5fGmJGdClEj3mAZh1BBxDpc-0-ba39dde62b4ceac07a256578391b75be)
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=1739250753-p2DOHLHFBF1Xdm78FrVRyjRpbSRS5e58-0-5f4adfb553ed57154168d82ac2c1fde9)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.2_1_59984.jpg?sign=1739250753-c5POAtSWnYky1Ss83PItAr689CzA5jaU-0-83544d175f1ea6ad784df2c60c883694)
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=1739250753-y40PvI059pjMrGwP6OErMSP9OtBVQzwU-0-f3a3031cd71f48911af242be9e6d0864)
表15.4 紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.4_59662.jpg?sign=1739250753-TyHSdNKmgPRd4173vUDfjD6ohA2LKoai-0-83057727ddf41f2807256a0497d15c77)
表15.5 紧急处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.5_13076.jpg?sign=1739250753-jW0awAajpSuYkLZN3LA596ExVOEjSnJD-0-8880ff65da717baf9ed9daf6e726e75d)
表15.6 进一步治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.6_13083.jpg?sign=1739250753-GeXku0bbHLRBTSXUaUqcmQGG4YxP70bv-0-506b9c97613f899c986dde218e6b9a49)
表15.7 溶栓治疗的指征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_13090.jpg?sign=1739250753-0B7BxWy4sftCtvB7imtNttniiYe27GpH-0-7350e81d969aff41e8b136129b45c777)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T15.7_1_13134.jpg?sign=1739250753-elBL0p0mvfbKcVZH6l6HV9SN5td9ecY8-0-8e259d684bd62213ea32f32029783aec)