肺血栓栓塞症的诊疗和治疗培训ppt课件

肺血栓栓塞症的肺血栓栓塞症的诊疗和治和治疗肺血栓栓塞症的诊疗和治疗1肺血栓栓塞症相关名词及定义肺血栓栓塞症诊断与治疗指南（草案）中的有关名词 肺血栓栓塞症(pulmonary thromboembolism,PTE)肺栓塞(pulmonary embolism,PE)肺梗死(pulmonary infarction,PI)深静脉血栓形成(deep venous thrombosis,DVT)静脉血栓栓塞症(venous thromboembolism,VTE)VTE=DVT+PTE其他相关名词 遗传性易栓症、慢性血栓栓塞性肺动脉高压、经济仓综合征、肺动脉原位血栓形成、特发性肺动脉高压、家族性肺动脉高压、出血性肺不张其他类型肺栓塞 气体栓塞、脂肪栓塞、羊水栓塞、脂肪栓塞、羊水栓塞、粟粒性肺栓塞（肿瘤、虫卵）、其他（菌栓、药栓）肺血栓栓塞症的诊疗和治疗2肺血栓栓塞症相关名词及定义肺血栓栓塞症诊断与治疗指南（草案）脂肪栓塞脂肪栓塞(fatembolismsyndrome,FES)定义：长管状骨骨折等严重创伤后脂长管状骨骨折等严重创伤后脂肪滴阻塞肺循环或脑循环等其他微血肪滴阻塞肺循环或脑循环等其他微血管而引起的临床症候群。主要临床表管而引起的临床症候群。主要临床表现为呼吸衰竭、脑功能障碍及淤斑。现为呼吸衰竭、脑功能障碍及淤斑。病理生理：肺血管的机械性梗阻和肺肺血管的机械性梗阻和肺间质的间质的“生物化学性生物化学性”炎症反应。炎症反应。肺血栓栓塞症的诊疗和治疗3脂肪栓塞(fatembolismsyndrome,FESFat embolism in a 58-year-old woman who presented with sudden dyspnea.The patient had undergone intramuscular injection of some fatty materials into the buttock several days earlier.(a)Radiograph shows bilateral ground-glass areas of increased opacity.肺血栓栓塞症的诊疗和治疗4Fatembolismina58-year-old(b)Thin-section(1-mm collimation)CT scan obtained at the level of the aortic arch shows widespread patchy ground-glass attenuation and consolidation.肺血栓栓塞症的诊疗和治疗5(b)Thin-section(1-mmcollima羊水栓塞羊水栓塞(amnioticfluidembolism,AFE)原因：妊娠期羊水中胎儿产物进入母体妊娠期羊水中胎儿产物进入母体循环而引起。循环而引起。途径：分娩时羊水经宫颈内膜血管静脉分娩时羊水经宫颈内膜血管静脉撕裂部位撕裂部位;胎盘早剥和剖宫产时损及胎盘胎盘早剥和剖宫产时损及胎盘附着部位的静脉窦附着部位的静脉窦;子宫损伤或子宫撕列子宫损伤或子宫撕列部位。部位。病理生理：肺血管栓塞肺血管栓塞;变态反应变态反应;凝血凝血机制障碍。机制障碍。肺血栓栓塞症的诊疗和治疗6羊水栓塞(amnioticfluidembolism,A(a)Radiograph shows bilateral widespread airspace consolidation.Endotracheal intubation was performed.AFE in a 40-year-old woman.The patient experienced sudden respiratory distress shortly after giving birth by caesarean section.肺血栓栓塞症的诊疗和治疗7(a)Radiographshowsbilater(b)On a follow-up radiograph obtained 3 days later,the extent of the parenchymal areas of increased opacity has decreased.A chest tube was inserted into the right pleural space to relieve the right pleural effusion.肺血栓栓塞症的诊疗和治疗8(b)Onafollow-upradiographDVT-PTE的流行病学发病率和患病率 西方国家：DVT和PTE的年发病率分别为1.0 和0.5 美国：PTE年新发病例数650，000-700，000 中国：阜外心血管病医院900例连续尸检：11.0（段以上PTE）易患因素 年龄与性别、血栓性静脉炎、静脉曲张、心肺脑血管疾病、创伤、肿瘤、制动、妊娠和口服避孕药、遗传因素、肥胖、吸烟等肺血栓栓塞症的诊疗和治疗9DVT-PTE的流行病学发病率和患病率肺血栓栓塞症的诊疗和治Table Risk Factors for VTESurgeryTrauma(major or lower extremity)Immobility,paresisMalignancyCancer therapy(hormonal,chemotherapy,or radiotherapy)Previous VTEIncreasing agePregnancy and the postpartum periodEstrogen-containing oral contraception or hormone replacementtherapySelective estrogen receptor modulatorsAcute medical illnessHeart or respiratory failureInflammatory bowel diseaseNephrotic syndromeMyeloproliferative disordersParoxysmal nocturnal hemoglobinuriaObesitySmokingVaricose veinsCentral venous catheterizationInherited or acquired thrombophilia20042004年年9 9月月ACCPACCP第第7 7次抗栓会议共识次抗栓会议共识肺血栓栓塞症的诊疗和治疗10TableRiskFactorsforVTE200Table Absolute Risk of DVT in HospitalizedPatients*Patient Group DVT Prevalence,%Medical patients 1020General surgery 1540Major gynecologic surgery 1540Major urologic surgery 1540Neurosurgery 1540Stroke 2050Hip or knee arthroplasty,hip fracture surgery 4060Major trauma 4080Spinal cord injury 6080Critical care patients 1080*Rates based on objective diagnostic testing for DVT in patients not receiving thromboprophylaxis.20042004年年9 9月月ACCPACCP第第7 7次抗栓会议共识次抗栓会议共识肺血栓栓塞症的诊疗和治疗11TableAbsoluteRiskofDVTin创伤（尸检（尸检PTE，15%）制 动肿瘤(尸检尸检PTE,10%)心肺脑血管病心肺脑血管病（PTE，10%）胫骨骨折（尸检尸检DVT，45%60%）腹部大大手术（尸检DVT，15%30%）胰腺癌（35%）充血性心衰（12%）髋骨骨折（尸检尸检DVT，50%75%）CABG术后（尸检DVT，3%9%）肺癌（20%）急性心肌梗塞（5%35%）脊髓损伤（尸检尸检DVT，50%100%）疝修补术（5%）泌尿道肿瘤（19%）脑卒中（下肢瘫痪）（30%60%）骨盆骨折（尸检尸检PTE，25%）结肠癌（15%）脊柱骨折（尸检尸检PTE，14%）胃癌（16%）乳腺癌（15%）附表部分病种DVT-PTE的患病情况肺血栓栓塞症的诊疗和治疗12创伤肿瘤心肺脑血管病胫骨骨折腹部大大手术胰腺癌充血性心衰髋骨国内资料国内资料488例住院脑卒中患者,下肢DVT总体检出率21.7%.493例骨科住院患者(创伤394人,关节置换92人,脊柱损伤52人),下肢DVT总体检出率为25.5%.肺血栓栓塞症的诊疗和治疗13国内资料488例住院脑卒中患者,下肢DVT总体检出率21.7DVT-PTE的诊断率的诊断率犹如冰山一角，尚需犹如冰山一角，尚需各临床和医技功能科各临床和医技功能科室的共同努力！室的共同努力！无声的杀手无声的杀手VTEVTELowdiagnosticrateofPE肺血栓栓塞症的诊疗和治疗14DVT-PTE的诊断率犹如冰山一角，尚需各临床和医技功能科室PTE的临床表现v病史 VTE 易患因素 家族性v症状v体征肺血栓栓塞症的诊疗和治疗15PTE的临床表现病史肺血栓栓塞症的诊疗和治疗15PTE的一般性检查动脉血气分析：低氧、呼减ECG：窦速、SIQIIITIII,V3RV5R、V V1 1的的S S波升支顿挫、粗钝和切迹，波升支顿挫、粗钝和切迹，V V1 1V V3 3的的T T波倒置、波倒置、ST段压低等等胸片心脏彩超：直接和间接征象深静脉超声D-二聚体（D-dimer）肺血栓栓塞症的诊疗和治疗16PTE的一般性检查动脉血气分析：低氧、呼减肺血栓栓塞症的诊疗PTEPTE的的ECGECG改变改变肺血栓栓塞症的诊疗和治疗17PTE的ECG改变肺血栓栓塞症的诊疗和治疗17PTEPTE的的ECGECG改变改变肺血栓栓塞症的诊疗和治疗18PTE的ECG改变肺血栓栓塞症的诊疗和治疗18case 1 taken on hospital admission shows well-marginated opacities over the right upper and middle lung zones,linear opacities over the right lower zone,and a blunted right costophrenic sulcus.X X 线线 胸胸 片片(一一)肺血栓栓塞症的诊疗和治疗19case1takenonhospitaladmX X 线线 胸胸 片片(二二)case 2 taken on hospital admission shows a wedge-shaped,pleural-based opacity with its apex directed toward the hilum in the left mid-lung zone,a homogenous opacity occupying the left lower zone,and blunting of the left costophrenic sulcus.肺血栓栓塞症的诊疗和治疗20X线胸片(二)case2takenonh肺血栓栓塞症的诊疗和治疗21肺血栓栓塞症的诊疗和治疗21深静脉超声肺血栓栓塞症的诊疗和治疗22深静脉超声肺血栓栓塞症的诊疗和治疗22PTE的确诊检查肺动脉造影（PAA）CT肺动脉造影（CTPA）V/Q扫描磁共振肺动脉造影（MRPA）肺血栓栓塞症的诊疗和治疗23PTE的确诊检查肺动脉造影（PAA）肺血栓栓塞症的诊疗和治疗肺动脉造影肺血栓栓塞症的诊疗和治疗24肺动脉造影肺血栓栓塞症的诊疗和治疗24CTPA(一一)In case 1 The contrast-enhanced spiral CT scan of the patient taken on hospital admission reveals intraluminal filling defects in both interlober pulmonary arteries,multiloculated pleural effusions,and atelectatic areas in the left lower lobe.肺血栓栓塞症的诊疗和治疗25CTPA(一)Incase1ThecontraCTPA(二二)In case 2 taken on hospital admission reveals an intraluminal filling defect in the right main pulmonary artery,multiloculated effusions,and atelectasis in both the posterior and paramediastinal regions of the right lung.肺血栓栓塞症的诊疗和治疗26CTPA(二)Incase2takenonCTPA(三三)CTV showslargelow-attenuationthrombifillingtheleftcommoniliacvein(arrow).CTPA shows multifocal low-shows multifocal low-attenuation emboli(arrows)in attenuation emboli(arrows)in segmental and subsegmental segmental and subsegmental arteries in the right lower lobe.arteries in the right lower lobe.肺血栓栓塞症的诊疗和治疗27CTPA(三)CTVshowslargelow-a肺血栓栓塞症的诊疗和治疗28肺血栓栓塞症的诊疗和治疗28CT scan in a patient with CTEPH shows a pleurabased wedge-shaped scar in the right upper lobe caused by prior infarction.Lung infarctionLung infarction肺血栓栓塞症的诊疗和治疗29CTscaninapatientwithCTEPV/Q扫描定性诊断：定性诊断：高度可能性高度可能性大于或等于大于或等于2 2个肺段灌注缺损，肺通气显个肺段灌注缺损，肺通气显像和像和X X胸片均未见异常胸片均未见异常;或灌注缺损区大于异常的肺通气或灌注缺损区大于异常的肺通气显像或显像或X X胸片；大于或等于胸片；大于或等于2 2个亚肺段（或一个肺段）的个亚肺段（或一个肺段）的肺灌注缺损，肺通气显像和肺灌注缺损，肺通气显像和X X胸片无明显异常。胸片无明显异常。中度可能性中度可能性低度可能性低度可能性肺血栓栓塞症的诊疗和治疗30V/Q扫描定性诊断：肺血栓栓塞症的诊疗和治疗30多发性肺栓塞多发性肺栓塞肺血栓栓塞症的诊疗和治疗31多发性肺栓塞肺血栓栓塞症的诊疗和治疗31MRPAAcute pulmonary embolism in a 41-year-old woman.Coronal gadolinium-enhanced three-dimensional pulmonary MR angiogram shows a large embolus(arrows)in the proximal right interlobar artery.肺血栓栓塞症的诊疗和治疗32MRPAAcutepulmonaryembolismiChronic pulmonary embolism in a 55-year-old man.(a)Chest radiograph shows enlargement of the central pulmonary arteries along with cardiomegaly.(b)CTPA obtained at the level of the bronchus intermedius shows eccentric thrombus along the medial margin of the narrowed right interlobar pulmonary artery(arrows).(c)V/Q scan(right posterior oblique view)shows multisegmental defects,which did not match the findings seen on a ventilation lung scan obtained with Tc-99m Technegas(d)Pulmonary arteriogram shows abrupt cutoff in rounded fashion(pouching defect)of the lower lobar arteries(arrow).(e)Photograph shows organized emboli filling the enlarged central pulmonary arteries.(arrows).肺血栓栓塞症的诊疗和治疗33ChronicpulmonaryembolisminPTE的治疗抗凝治疗溶栓治疗介入治疗 肺血栓栓塞症的诊疗和治疗34PTE的治疗抗凝治疗肺血栓栓塞症的诊疗和治疗34抗凝治疗v药物v监测v特殊情况下的抗凝治疗：妊娠和哺乳、围手术期、恶性肿瘤v抗凝治疗的终止。肺血栓栓塞症的诊疗和治疗35抗凝治疗药物肺血栓栓塞症的诊疗和治疗35各种LMWH的推荐用法依诺肝素钠（克塞）：100IU/kg,Q12h达肝素钠（法安明）：100IU/kg,Q12h那屈肝素钙（速避凝）：Q12h 50kg,0.4ml;5059kg,0.5ml;6069kg,0.6ml;7079kg,0.7ml;8089kg,0.8ml;90kg,0.9ml.肺血栓栓塞症的诊疗和治疗36各种LMWH的推荐用法依诺肝素钠（克塞）：100IU/kg,Body Weight-Based Dosing of IV Heparin（ACCP 第六次抗栓会议共识）肺血栓栓塞症的诊疗和治疗37BodyWeight-BasedDosingofIVGuidelines for Anticoagulation:Unfractioned Heparin（ACCP 第六次抗栓会议共识）肺血栓栓塞症的诊疗和治疗38GuidelinesforAnticoagulationDuration of Therapy（ACCP 第六次抗栓会议共识）肺血栓栓塞症的诊疗和治疗39DurationofTherapy（ACCP第六次抗长期抗凝华法令用法、监测、疗程、副作用常见影响华法令作用的药物和疾病：加强加强作用：作用：乙胺碘呋酮、广谱抗生素、洛伐他汀、流乙胺碘呋酮、广谱抗生素、洛伐他汀、流感疫苗、奥美拉唑、扑热息痛、甲硝唑和甲状腺感疫苗、奥美拉唑、扑热息痛、甲硝唑和甲状腺激素等；甲亢、老年、心衰、肝病、发热、维生激素等；甲亢、老年、心衰、肝病、发热、维生素素K缺乏、恶性肿瘤等。缺乏、恶性肿瘤等。抑制作用：抑制作用：巴比妥类、口服避孕药、利福平和肾巴比妥类、口服避孕药、利福平和肾上腺皮质激素等；甲减、肾病综合征和遗传性华上腺皮质激素等；甲减、肾病综合征和遗传性华法令耐药等。法令耐药等。肺血栓栓塞症的诊疗和治疗40长期抗凝华法令用法、监测、疗程、副作用肺血栓栓塞症的诊疗抗凝治疗的紧急终止抗凝治疗的紧急终止肝素：半衰期1.5小时，硫酸鱼精蛋白1mg可中和不少于100u的肝素，通常只需半量。华法令：半衰期约42小时，维生素K1 15mg口服或静注，24小时内能终止抗凝。紧急情况输新鲜冰冻血浆或补充维生素K依赖性凝血因子。LMWH：半衰期约6小时，每0.6mg鱼精蛋白可中和速避凝0.1ml肺血栓栓塞症的诊疗和治疗41抗凝治疗的紧急终止肝素：半衰期1.5小时，硫酸鱼精蛋白1mg溶栓治疗适应症溶栓方案：尿激酶12小时溶栓方案、重组组织型纤溶酶原激活剂2小时溶栓方案等其他问题：DVT、咯血、二次溶栓、妊娠、症状性PTE护理肺血栓栓塞症的诊疗和治疗42溶栓治疗适应症肺血栓栓塞症的诊疗和治疗42介入治疗 适应症与并发症；方案的选择；腔静脉滤器的应用。肺动脉导管溶栓机械破碎滤器置入肺血栓栓塞症的诊疗和治疗43介入治疗适应症与并发症；方案的选择；腔静脉滤器的应用。肺左肺动脉栓子去除肺血栓栓塞症的诊疗和治疗44左肺动脉栓子去除肺血栓栓塞症的诊疗和治疗44下腔静脉滤网肺血栓栓塞症的诊疗和治疗45下腔静脉滤网肺血栓栓塞症的诊疗和治疗45CTEPH Contrast-enhanced CT scan in a patient with CTEPH shows bronchial artery collaterals.Note that the enlarged main pulmonary artery has a larger diameter than the AO.肺血栓栓塞症的诊疗和治疗46CTEPHContrast-enhancedCTsca谢谢！谢谢！肺血栓栓塞症的诊疗和治疗47谢谢！肺血栓栓塞症的诊疗和治疗47Pulmonary HypertentionWANG JinxiangRespiratory Department of Beijing Luhe Hospital肺血栓栓塞症的诊疗和治疗48PulmonaryHypertentionWANGJin肺血栓栓塞症的诊疗和治疗49肺血栓栓塞症的诊疗和治疗49肺血栓栓塞症的诊疗和治疗50肺血栓栓塞症的诊疗和治疗50肺血栓栓塞症的诊疗和治疗51肺血栓栓塞症的诊疗和治疗51Pulmonary HypertentionvClassification vFunctional ClassificationvDiagnostic PrecedurevTherapy肺血栓栓塞症的诊疗和治疗52PulmonaryHypertentionClassifi肺血栓栓塞症的诊疗和治疗培训ppt课件532003,VinicePulmonary arterial hypertension(PAH)Pulmonary hypertension with left heart diseasePulmonary hypertension associated with lung disease and/or hypoxPulmonary hypertension due to chronic thrombotic and/or embolic diseaseMiscellaneous肺血栓栓塞症的诊疗和治疗542003,Vinice肺血栓栓塞症的诊疗和治疗54Pulmonary arterial hypertension(PAH)1.1.Idiopathic(IPAH)1.2.Familial(FPAH)1.3.Associated with(APAH):1.3.1.Collagen vascular disease 1.3.2.Congenital systemic-to-pulmonary shunts 1.3.3.Portal hypertension 1.3.4.HIV infection 1.3.5.Drugs and toxins 1.3.6.Other(thyroiddisorders,glycogenstoragedisease,Gaucherdisease,hereditaryhemorrhagictelangiectasia,hemoglobinopathies,myeloproliferativedisorders,splenectomy)1.4 Associated with significant venous or capillary involvement1.4.1 Pulmonary veno-occlusive disease(PVOD)1.4.2 Pulmonary capillary hemangiomatosis(PCH)肺血栓栓塞症的诊疗和治疗55PulmonaryarterialhypertensioPulmonary hypertension with left heart disease2.1.Left-sided atrial or ventricular heart disease 2.2.Left-sided valvular heart disease 肺血栓栓塞症的诊疗和治疗56PulmonaryhypertensionwithlePulmonary hypertension associated with lung disease and/or hypoxemia3.1.Chronic obstructive pulmonary disease 3.2.Interstitial lung disease 3.3.Sleep-disordered breathing 3.4.Alveolar hypoventilation disorders 3.5.Chronic exposure to high altitude 3.6.Developmental abnormalities肺血栓栓塞症的诊疗和治疗57PulmonaryhypertensionassociaPulmonary hypertension due to chronic thrombotic and/or embolic disease4.1.Thromboembolic obstruction of proximal pulmonary arteries 4.2.Thromboembolic obstruction of distal pulmonary arteries 4.3.Non-thrombotic pulmonary embolism(tumor,parasites,foreign material)肺血栓栓塞症的诊疗和治疗58PulmonaryhypertensionduetoMiscellaneousSarcoidosishistiocytosis-XLymphangiomatosiscompression of pulmonary vessels(adenopathy,tumor,fibrosing mediastinitis)肺血栓栓塞症的诊疗和治疗59Miscellaneous肺血栓栓塞症的诊疗和治疗59Functional Classification（WHO,2004,Chest）Class I:Patients with PH without limitation ofusualactivityClassII:PatientswithPHwithslightlimitationofusualphysicalactivityClassIII:PatientswithPHwithmarkedlimitationofusualphysicalactivityClass IV:Patients with PH with inability toperform any physical activity without symptomsand who may have signs of right ventricularfailure肺血栓栓塞症的诊疗和治疗60FunctionalClassification（WHOA.New York Heart Association functional classification*Class1:Nosymptomswithordinaryphysicalactivity.Class2:Symptomswithordinaryactivity.Slightlimitationofactivity.Class3:Symptomswithlessthanordinaryactivity.Markedlimitationofactivity.Class4:Symptomswithanyactivityorevenatrest.B.World Health Organization functional assessment classificationClassI:PatientswithPHbutwithoutresultinglimitationofphysicalactivity.Ordinaryphysicalactivitydoesnotcauseunduedyspneaorfatigue,chestpain,ornearsyncope.ClassII:PatientswithPHresultinginslightlimitationofphysicalactivity.Theyarecomfortableatrest.Ordinaryphysicalactivitycausesunduedyspneaorfatigue,chestpain,ornearsyncope.ClassIII:PatientswithPHresultinginmarkedlimitationofphysicalactivity.Theyarecomfortableatrest.Lessthanordinaryactivitycausesunduedyspneaorfatigue,chestpain,ornearsyncope.ClassIV:PatientswithPHwithinabilitytocarryoutanyphysicalactivitywithoutsymptoms.Thesepatientsmanifestsignsofright-heartfailure.Dyspneaand/orfatiguemayevenbepresentatrest.DiscomfortisincreasedbyanyphysicalactivityClassification（Contrast of NYHA and WHO）肺血栓栓塞症的诊疗和治疗61A.NewYorkHeartAssociationHemodynamicclassificationMild:mPAP2635mmHgModerate:mPAP3645mmHgsevere:mPAP46mmHg肺血栓栓塞症的诊疗和治疗62HemodynamicclassificationMild Essential EvaluationContingent EvaluationHistoryandphysicalexamination；TransesophagealechoChestx-ray；EchowithbubblestudyElectrocardiogram；CTchesthighresolutionPulmonaryfunctiontesting；PulmonaryangiogramVentilation-perfusionscan；ArterialbloodgasTransthoracicecho；CardiacMRIBloodtests:HIV,TFTs,LFTs,ANA；Bloodtests:Uricacid,BNPSix-minutewalktest；PolysomnographyOvernightoximetry；CardiopulmonaryexerciseRightheartcatheterization；OpenlungbiopsySuspect PH肺血栓栓塞症的诊疗和治疗63EssentialEvaluationECG characteristics of PAHECG characteristics of PAH肺血栓栓塞症的诊疗和治疗64ECGcharacteristicsofPAH肺血栓栓Chest x-ray of PAH肺血栓栓塞症的诊疗和治疗65Chestx-rayofPAH肺血栓栓塞症的诊疗和治疗Therapy of PAH肺血栓栓塞症的诊疗和治疗66TherapyofPAH肺血栓栓塞症的诊疗和治疗66Pulmonary Angiography in PAHThe amount of blood clot that you can see there;the vessels tapering,the abrupt cutoffs of the blood vessels.The pictures been taken out at the time of a pulmonary thrombo-endarterectomy.This is chronic fibrotic organized material;it is not fresh clot.肺血栓栓塞症的诊疗和治疗67PulmonaryAngiographyinPAHTh王金祥,胥振扬,李晓辉,等.21例肺血栓栓塞症临床分析.中国呼吸与危重监护杂志.2003,2(5):367-371.【被引情况】【被引情况】共共 8 篇篇 胡瑞霞 宋伯良：肺栓塞26例临床分析 下载全文来自中华实用中西医杂志中华实用中西医杂志 2005 年 第 15 期 于雷 徐海燕 肖庆龙：胸部手术后急性肺栓塞的诊疗 下载全文 来自中国急救医学中国急救医学 2004 年 第 06 期 李利红 王辰 陈世伦 庞宝森 王峰 伍燕兵 牛淑杰：不同溶栓方案治疗肺栓塞时凝血纤溶变化的实验研究 下载全文 来自中国呼吸与危重监护杂志中国呼吸与危重监护杂志 2005 年 第 03 期 张卓然 时国朝：11例肾病综合征并发肺栓塞临床病理分析 下载全文 来自中国呼吸与危重监中国呼吸与危重监护杂志护杂志 2005 年 第 01 期 李文兵 高德伟 俞森洋 刘长庭：肺血栓栓塞与肺梗死形成的临床和病理特征及其相关因素分析 下载全文 来自中国呼吸与危重监护杂志中国呼吸与危重监护杂志 2004 年 第 02 期 王蓉美 张小瑜 李小波 冯玉麟：影像诊断在肺栓塞中的应用进展 下载全文 来自中国呼吸与中国呼吸与危重监护杂志危重监护杂志 2004 年 第 01 期 彭燕：肺血栓栓塞症22例误诊分析 下载全文 来自中中国呼吸与危重监护杂志国呼吸与危重监护杂志 2004 年 第 01 期 谢美云 穆耀强 金兰花：35例肺栓塞的诊治体会 下载全文 来自中国呼吸与危重监护杂志中国呼吸与危重监护杂志 2004 年 第 01 期 王金祥,石逸杰,胥振扬,等.家族性肺动脉高压家二例.中国呼吸与危重监护杂志.2006,5(6):463.肺血栓栓塞症的诊疗和治疗68王金祥,胥振扬,李晓辉,等.21例肺血栓栓塞症临床分析.中国