摘要
目的分析以晕厥即意识丧失为首发表现的肺动脉栓塞病人的临床特点及诊疗方法。方法本文报道1例以意识丧失为首发表现的急性肺栓塞的患者,对其临床资料,诊断思路和治疗过程进行分析,并针对肺栓塞病人意识丧失发生的病理生理机制,意识丧失病人全面的诊断和筛查思路,针对怀疑肺栓塞的病人相应的临床可能性的相关评估,明确肺栓塞诊断后下一步诊疗计划的制定,肺栓塞病因的相关筛查等进行相应的讨论总结。结果本例患者为一例非常少见的以单纯意识丧失为首发表现的急性肺栓塞,入院后经完善肺动脉CTPA明确诊断后评估其严重程度,予以低分子肝素序贯重叠口服华法林强化抗凝治疗,后患者生命体征平稳,无特殊不适主诉,遂平稳出院,目前患者仍在进一步的临床随访当中。结论总结本例病例,针对晕厥合并呼吸困难的患者需警惕肺栓塞可能,需第一时间明确晕厥患者的生命体征,心率,心电图,呼吸及血氧饱和度的情况,必要时迅速给予高危患者合适的呼吸支持及血压支持,上述基础生命体征存在问题的相应患者需高度怀疑心肺器质性疾病所致意识丧失,尽快完善肺栓塞临床可能性评估及D-二聚体筛查后应根据情况酌情行PTCA协助明确或排除肺栓塞诊断,同时需评估肺栓塞病情危重程度,后酌情予以再灌注或抗凝治疗,之后需完善病因相关筛查,完善病史,明确患者有哪些肺栓塞相关易患因素,针对病因予以相应处理或病情指导,避免肺栓塞再发或加重。
Objective To analyze the clinical characteristics and diagnosis and treatment of patients diagnosed as pulmonary embolism(PE)with syncope or loss of consciousness as the first manifestation.Methods This article reported a case of acute pulmonary embolism with loss of consciousness as the first manifestation,we analyzed its clinical data,diagnostic procedure and treatment process,and then we discussed and summarized the pathophysiological mechanism of the loss of consciousness in patients with pulmonary embolism,the comprehensive diagnosis and screening thinking of patients with loss of consciousness,and the relevant assessment of the corresponding clinical possibility of patients suspected of pulmonary embolism,the follow-up steps of diagnosis and treatment plan after a definite diagnosis,the related screening of pulmonary embolism etiology etc.Results This case is a very rare case of acute pulmonary embolism with simply loss of consciousness as the first manifestation.After the completion of pulmonary artery CTPA diagnosis,the severity of the acute pulmonary embolism was evaluated,then the patient was given low molecular heparin sequentially overlapping oral warfarin as the anticoagulation treatment.After that,the life signs of the patient was stable,no special complaints,thus this patient was discharged smoothly.At present,the patient is still in further clinical follow-up.Conclusion To summarize this case,it is necessary to be aware of the possibility of pulmonary embolism in patients with syncope complicated with dyspnea.It is necessary to acquire the vital signs,such as heart rate,electrocardiogram,respiration and blood oxygen saturation in first clinical touch among syncope patients as soon as possible.If necessary,appropriate respiratory support and blood pressure support should be given to high-risk patients.The corresponding patients with problems in above-mentioned basic vital signs should be highly suspected of cardiopulmonary diseases,PTCA should be performed as soon as possible after the evaluation of the clinical possibility of pulmonary embolism and D-dimer screening.At the same time,the critical degree of pulmonary embolism should be evaluated,and then reperfusion or anticoagulation treatment should be performed appropriately.After that,the etiology screening should be done.To avoid recurrence or aggravation of pulmonary embolism,we should deal with the cause of the disease and establish guidance-system.
作者
柴众一
CHAI Zhong-yi(People's Hospital of Peking University,Beijing 100044,China)
出处
《医药论坛杂志》
2020年第6期83-86,90,共5页
Journal of Medical Forum
关键词
意识丧失
肺栓塞
临床可能性
病因筛查
Loss of consciousness
Pulmonary embolism
Clinical possibility
Etiology screening
