肺栓塞

Pulmonary embolism
Pulmonary embolism
	肺部的计算机断层成像显示出肺栓塞（箭头所指处）
症状	Hampton hump[]、Westermark sign[]
类型	pulmonary artery disease[*]、疾病
分类和外部资源
医学专科	心脏内科、血液学、胸腔医学
ICD-11	BB00
ICD-10	I26
ICD-9-CM	415.1
DiseasesDB	10956
MedlinePlus	000132
eMedicine	med/1958 emerg/490 radio/582
MeSH	D011655
	[编辑此条目的维基数据]

肺栓塞^[1]（pulmonary embolism，PE）是体循环的各种栓子（内源性或外源性栓子）阻塞肺动脉或其分支，从而引起肺循环和呼吸功能障碍的一组疾病或临床综合症。肺血栓栓塞^[2]^[3]（pulmonary thromboembolism，PTE）为最常见的肺栓塞，其为来自静脉系统或右心的血栓阻塞肺动脉或其分支所致的疾病，全名肺动脉血栓栓塞^[4]^[5]（pulmonary artery thromboembolism）。

肺栓塞一般指急性肺动脉栓塞^[6]，少数为慢性肺动脉栓塞^[7]。肺栓塞的症状有呼吸困难、吸气时胸痛，以及咳血等等^[8]，也可能会出现下肢静脉血栓的症状，使下肢产生红、肿、痛等情形^[8]。肺栓塞的症状有氧气浓度降低、呼吸急促、心跳加速，以及些微发热^[9]。严重的病例可能会出现昏厥、休克，甚至猝死等^[10]。

肺栓塞时常肇因于下肢血栓行至肺部^[1]。而血栓形成的风险因子有罹患癌症或某些遗传疾病、卧床（英语：Bed rest）过久、吸烟、中风、使用激素替代疗法、怀孕、患有肥胖、曾接受过某些手术^[11]。有些案例的肺栓塞是由气泡、脂肪栓塞或羊水所造成的^[12]^[13]。诊断时需要结合临床症状及检验结果来做确诊^[14]。如果风险较低，可以检测D-dimer（英语：D-dimer）来排除可能的情形^[14]。肺血管电脑断层摄影（英语：CT pulmonary angiography）、肺脏血流灌注扫描（英语：lung ventilation/perfusion scan），或照腿部超声波等等^[14]。深静脉栓塞与肺栓塞可以合称为静脉血栓栓塞（英语：venous thromboembolism）（venous thromboembolism，VTE）^[15]。

预防肺栓塞发生有以下方法，如术后尽快活动、久坐时进行腿部运动，在某些手术后使用抗凝剂^[16]。治疗时需搭配使用抗凝剂，像是肝素、华法林或是某种直接口服抗凝血剂（简称为 DOACs）^[17]等，以上皆建议至少使用三个月^[17]。严重的病例可能需要血栓溶解（英语：thrombolysis）用药，例如经由静脉或插导管给抗凝血药组织纤维溶酶原活化剂（英语：Tissue plasminogen activator）（简称为 tPA）或是接受手术（如肺栓塞取栓术（英语：Pulmonary thrombectomy）^[18] 。如果病患状况不适合使用抗凝剂，可考虑使用暂时性下腔静脉过滤器（英语：vena cava filter）^[18]。

在欧洲，一年约有 43 万人罹患肺栓塞^[19]，在美国，一年约有 30 到 60 万名病例^[1]^[20]，其中约有 5 万^[20]到 20 万起致死案例^[21]，男女患病比例几乎均等^[11]。随着年龄增加，罹患此症越见普遍^[11]。

参见

深静脉血栓

参考资料

^ ^1.0 ^1.1 ^1.2 What Is Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于12 March 2016）.
^ Goggs, Robert, et al. "Pulmonary thromboembolism." Journal of Veterinary Emergency and Critical Care 19.1 (2009): 30-52.
^ Sasahara, Arthur A., et al. "Pulmonary thromboembolism: diagnosis and treatment." Jama 249.21 (1983): 2945-2950.
^ Rittoo, Dylmitr, and George R. Sutherland. "Acute pulmonary artery thromboembolism treated with thrombolysis: diagnostic and monitoring uses of transoesophageal echocardiography." Heart 69.5 (1993): 457-459.
^ CIVELEK, A. CAHID M.D.,*; WANG, ERIC A. M.D.,*; BARR, LINDA M.D.,†; URBAN, BRUCE A. M.D.*; ENG, JOHN M.D.*. Asymptomatic Large Main Pulmonary Artery Thromboembolism with a Low-Probability Ventilation–Perfusion Lung Scan. Clin Nuclear Med 26(3):p 216-220, March 2001.
^ Agnelli G, Becattini C. Acute pulmonary embolism[J]. New England Journal of Medicine, 2010, 363(3): 266-274.
^ Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther. 2018;8(3):253-271. doi:10.21037/cdt.2018.01.09
^ ^8.0 ^8.1 What Are the Signs and Symptoms of Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于9 March 2016）.
^ Tintinalli JE. Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) 7. New York: McGraw-Hill Companies. 2010: 432. ISBN 978-0-07-148480-0.
^ Goldhaber SZ. Pulmonary thromboembolism. Kasper DL, Braunwald E, Fauci AS, et al (编). Harrison's Principles of Internal Medicine 16th. New York, NY: McGraw-Hill. 2005: 1561–65. ISBN 978-0-07-139140-5.
^ ^11.0 ^11.1 ^11.2 Who Is at Risk for Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于15 February 2016）.
^ What Causes Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.
^ Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M. Amniotic fluid embolism: review. Current Pharmaceutical Biotechnology. 2014, 14 (14): 1163–7. PMID 24804726. doi:10.2174/1389201015666140430161404.
^ ^14.0 ^14.1 ^14.2 How Is Pulmonary Embolism Diagnosed?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.
^ Other Names for Pulmonary Embolism. July 1, 2011 [12 March 2016]. （原始内容存档于16 March 2016）.
^ How Can Pulmonary Embolism Be Prevented?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.
^ ^17.0 ^17.1 Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. February 2016, 149 (2): 315–352. PMID 26867832. doi:10.1016/j.chest.2015.11.026.
^ ^18.0 ^18.1 How Is Pulmonary Embolism Treated?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于9 March 2016）.
^ Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arteriosclerosis, Thrombosis, and Vascular Biology. November 2014, 34 (11): 2363–71. PMID 25304324. doi:10.1161/atvbaha.114.304488.
^ ^20.0 ^20.1 Rahimtoola A, Bergin JD. Acute pulmonary embolism: an update on diagnosis and management. Current Problems in Cardiology. February 2005, 30 (2): 61–114. PMID 15650680. doi:10.1016/j.cpcardiol.2004.06.001.
^ Kumar V, Abbas AK, Fausto N, Mitchell RN. Basic Pathology. New Delhi: Elsevier. 2010: 98. ISBN 978-81-312-1036-9.

医疗科学 - 医学 - 血液学 - 编辑
骨髓恶性肿瘤和白血球
淋巴系统: 淋巴型白血病（急性、慢性） \| 淋巴瘤（何杰金氏病、非何杰金氏淋巴瘤） \| 淋巴增殖性病变 \| 骨髓癌（多发性骨髓癌、质浆细胞瘤）
骨髓: 骨髓性白血病 (急性、慢性) \| 骨髓增殖性疾病（原发性血小板增多症、红血球增多症） \| 骨髓成形不良综合症 \| 骨髓纤维化 \| 嗜中性白血球过低症
红血球
贫血 \| 血色病 \| 镰刀型红血球疾病 \| 地中海贫血 \| 溶血反应 \| 再生不良性贫血 \| 蚕豆症 \| 遗传性球形红细胞增多症 \| 遗传性椭圆形红血球增多症 \| 其他血红蛋白病
凝血因子和血小板
血栓形成 \| 深静脉血栓形成 \| 肺栓塞 \| 血友病 \| 自发性血小板缺乏紫斑症 \| 血栓性血小板缺乏紫斑症 \| 弥散性血管内凝血

[NIH2011What-1] 1.0 ^1.1 ^1.2 What Is Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于12 March 2016）.

[2] Goggs, Robert, et al. "Pulmonary thromboembolism." Journal of Veterinary Emergency and Critical Care 19.1 (2009): 30-52.

[3] Sasahara, Arthur A., et al. "Pulmonary thromboembolism: diagnosis and treatment." Jama 249.21 (1983): 2945-2950.

[4] Rittoo, Dylmitr, and George R. Sutherland. "Acute pulmonary artery thromboembolism treated with thrombolysis: diagnostic and monitoring uses of transoesophageal echocardiography." Heart 69.5 (1993): 457-459.

[5] CIVELEK, A. CAHID M.D.,*; WANG, ERIC A. M.D.,*; BARR, LINDA M.D.,†; URBAN, BRUCE A. M.D.*; ENG, JOHN M.D.*. Asymptomatic Large Main Pulmonary Artery Thromboembolism with a Low-Probability Ventilation–Perfusion Lung Scan. Clin Nuclear Med 26(3):p 216-220, March 2001.

[6] Agnelli G, Becattini C. Acute pulmonary embolism[J]. New England Journal of Medicine, 2010, 363(3): 266-274.

[7] Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther. 2018;8(3):253-271. doi:10.21037/cdt.2018.01.09

[NIH2011Sym-8] 8.0 ^8.1 What Are the Signs and Symptoms of Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于9 March 2016）.

[Tint2010-9] Tintinalli JE. Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) 7. New York: McGraw-Hill Companies. 2010: 432. ISBN 978-0-07-148480-0.

[Goldhaber-10] Goldhaber SZ. Pulmonary thromboembolism. Kasper DL, Braunwald E, Fauci AS, et al (编). Harrison's Principles of Internal Medicine 16th. New York, NY: McGraw-Hill. 2005: 1561–65. ISBN 978-0-07-139140-5.

[NIH2011Risk-11] 11.0 ^11.1 ^11.2 Who Is at Risk for Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于15 February 2016）.

[12] What Causes Pulmonary Embolism?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.

[13] Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M. Amniotic fluid embolism: review. Current Pharmaceutical Biotechnology. 2014, 14 (14): 1163–7. PMID 24804726. doi:10.2174/1389201015666140430161404.

[NIH2011Diag-14] 14.0 ^14.1 ^14.2 How Is Pulmonary Embolism Diagnosed?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.

[15] Other Names for Pulmonary Embolism. July 1, 2011 [12 March 2016]. （原始内容存档于16 March 2016）.

[16] How Can Pulmonary Embolism Be Prevented?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于7 April 2016）.

[Chest2016-17] 17.0 ^17.1 Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. February 2016, 149 (2): 315–352. PMID 26867832. doi:10.1016/j.chest.2015.11.026.

[NIH2011Tx-18] 18.0 ^18.1 How Is Pulmonary Embolism Treated?. NHLBI. July 1, 2011 [12 March 2016]. （原始内容存档于9 March 2016）.

[Ras2014-19] Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arteriosclerosis, Thrombosis, and Vascular Biology. November 2014, 34 (11): 2363–71. PMID 25304324. doi:10.1161/atvbaha.114.304488.

[Epi2005-20] 20.0 ^20.1 Rahimtoola A, Bergin JD. Acute pulmonary embolism: an update on diagnosis and management. Current Problems in Cardiology. February 2005, 30 (2): 61–114. PMID 15650680. doi:10.1016/j.cpcardiol.2004.06.001.

[Robbins_Pathology-21] Kumar V, Abbas AK, Fausto N, Mitchell RN. Basic Pathology. New Delhi: Elsevier. 2010: 98. ISBN 978-81-312-1036-9.

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