人工瓣膜血栓诊断与治疗.ppt

人工瓣膜血栓诊断与治疗,汇报内容,溶栓治疗,人工瓣膜血栓的形成,人工瓣膜血栓是瓣膜置换术后的严重并发症之一。发生率：10%/年发达国家：0.3%-1.3%发展中国家：6.1%机械瓣（主动脉瓣+二尖瓣）：0.5%-8%机械瓣（三尖瓣）：20%生物瓣：0.03%,GursoyMo.etal.Thecurrentstatusoffluoroscopyandechocardiographyinthediagnosisofprostheticvalvethrombosisareviewarticle.Echocardiography.2015,32:156-164,人工瓣膜血栓形成的高危因素,GursoyMo.etal.Thecurrentstatusoffluoroscopyandechocardiographyinthediagnosisofprostheticvalvethrombosisareviewarticle.Echocardiography.2015,32:156-164,人工瓣膜血栓的危害,F.M.Castilhoetal.Thrombolytictherapyorsurgeryforvalveprosthesisthrombosis:systematicreviewandmeta-analysis.JthrombHaemost,2014,12:1218-28,人工瓣膜血栓的评估和管理,呼吸困难、栓塞事件,二尖瓣/主动脉瓣,三尖瓣/肺动脉,2014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease,级：患者有心脏病，但日常活动量不受限制，一般体力活动不引起过度疲劳、心悸、气喘或心绞痛。级：心脏病患者的体力活动轻度受限制。休息时无自觉症状，一般体力活动引起过度疲劳、心悸、气喘或心绞痛。级：患者有心脏病，以致体力活动明显受限制。休息时无症状，但小于一般体力活动即可引起过度疲劳、心悸、气喘或心绞痛。级：心脏病患者不能从事任何体力活动，休息状态下也出现心衰症状，体力活动后加重。,经胸彩超,经食道彩超,左侧血栓的治疗策略,2014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease2012ACCP-9:AntithromboticandThrombolyticTherapyforValvularDisease2012ESC/EACTSGuidelinesonthemanagementofvalvularheartdisease,人工瓣膜血栓的治疗,2014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease,溶栓方案,Raymondetal.FibrinolysisofMechanicalProstheticValveThrombosisASingle-CenterStudyof127Case.JACC,2003,41(4):653-82014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease,溶栓的疗程,G.Karthikeyanelat.Timingofadverseeventsduringfibrinolytictherapywithstreptokinaseforleft-sidedprostheticvalvethrombosis.JThrombThrombolysis.2011,32:146-149,溶栓效果的评价,GanasanKarthikeyan,etal.Urgentsurgerycomparedwithfibrinolytictherapyforthetreatmentofleft-sidedprostheticheartvalvethrombosis:asystematicreviewandmeta-analysisofobservationalstudies.EurpeanHeartJournal,2013,34:1557-1566,经胸彩超,X线透视,抗凝,SK、UKorrt-PA:fibrinolytictherapyissuccessfull,IntravenousUFH+VKA,4-6h,VKA,Arotic:3.0-4.0,Mitral:3.5-4.5,INR,1.2014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease2.G.Karthikeyanelat.Timingofadverseeventsduringfibrinolytictherapywithstreptokinaseforleft-sidedprostheticvalvethrombosis.JThrombThrombolysis.2011,32:146-149,溶栓的禁忌症,2014AHA/ACCGuidelinefortheManagementofPatientswithValvularHeartDisease,溶栓的并发症,17.8%,死亡,F.M.Castilhoetal.Thrombolytictherapyorsurgeryforvalveprosthesisthrombosis:systematicreviewandmeta-analysis.JthrombHaemost,2014,12:1218-28,溶栓并发症的时间,G.Karthikeyanelat.Timingofadverseeventsduringfibrinolytictherapywithstreptokinaseforleft-sidedprostheticvalvethrombosis.JThrombThrombolysis.2011,32:146-149,1,2,3,人工瓣膜血栓是瓣膜置换术后严重的并发症。抗凝不足是其主要原因。3.加强患者用药教育尤为重要。,对怀疑为人工瓣膜血栓的应尽早使用TTE、TEE进行诊断。2.人工瓣膜血栓治疗方案的选择主要根据血栓大小及心功能分级。,总结,溶栓治疗的选择应充分考虑患者是否存在禁忌症。2.溶栓方案的制订应从溶栓药物的选择、疗程、效果评价等方面进行考虑。,临床药师可以从患者用药教育、治疗方案的选择、溶栓方案的制订、抗凝治疗的监护等方面充分发挥作用。,ThankYou!,