肺血栓栓塞症抗血栓治疗新进展  

The new progress of the antithrombotic treatment of the pulmonary thromboembolism

作　　者：李圣青[1] 

机构地区：[1]第四军医大学西京医院呼吸与危重症医学科,西安710032

出　　处：《中国实用内科杂志》2013年第5期348-351,共4页Chinese Journal of Practical Internal Medicine

摘　　要：肺血栓栓塞症(PTE)分急性肺栓塞和慢性血栓栓塞性肺动脉高压(CTEPH)。PTE的抗栓治疗分为初始治疗和长期治疗。初始治疗包括胃肠外抗凝、系统性溶栓、导管血栓清除术、外科血栓切除术和腔静脉滤器植入术等。长期治疗需综合考虑患者静脉血栓栓塞症(VTE)的易感因素和出血风险,分为(1)短期抗凝治疗;(2)3个月抗凝;(3)长程治疗(如6或12个月);(4)长期治疗。CTEPH的首要治疗是肺动脉血栓内膜剥脱术(PEA);对于不适合PEA手术的患者,建议使用肺动脉靶向降压药物并长期抗凝。The pulmonary thromboembolism is divided into acute pulmonary embolism and chronic thromboembolic pulmona- ry hypertension （CTEPH）. Antithrombotie treatment of acute pulmonary embolism is divided into the initial treatment and long-term treatment. Initial treatment includes parenteral anticoagulation, systemic thrombolysis, catheter thrombectomy, sur- gical thrombeetomy and vena cava filter implantation. Long-term treatment needs comprehensive consideration in patients with predisposing factors for VTE and bleeding risk factors. It is divided into （ 1 ） treatment of a shorter period ; （ 2 ） treatment with anticoagulation for 3 months ; （ 3 ） treatment of a longer time-limited period （ eg ,6 or 12 months ） ; （ 4 ） extended therapy. In selected patients with CTEPH, such as those with central disease under the care of an experienced thromboendarterectomy team, we suggest pulmonary thromboendarterectomy （PEA）. In those patients not suitable for the PEA surgery,it is recom-mended that the use of the pulmonary targeting antihypertensive drugs and long-term anticoagulation.

关 键 词：急性肺栓塞 慢性血栓栓塞性肺动脉高压 抗凝 溶栓 肺动脉血栓内膜剥脱术 

分 类 号：R364.15[医药卫生—病理学]