兰州大学机构库 >学院待认领
肺栓塞与慢性阻塞性肺疾病
Alternative TitlePulmonary embolism and chronic obstructive pulmonary disease
柳彦涛
Thesis Advisor岳红梅
2010-05-10
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword肺栓塞 慢性阻塞性肺疾病
Abstract慢性阻塞性肺疾病(COPD)在世界范围内是一个重要的健康问题。每年导致超过3百万人死亡,已经成为第4位导致死亡的原因。预计到2020年,COPD将成为继缺血性心脏病和卒中之后的第3位致死原因。大多数COPD导致的死亡均发生在病情急性加重期。研究表明慢性阻塞性肺疾病急性加重(AECOPD)者50%~70%由感染引起,10%由环境污染引起,还有超过30%原因不明。静脉血栓性疾病(VTE)可以引起咳嗽及呼吸困难,因此肺栓塞(PE)可能是COPD加重的另一个常见原因。据估计,有25%的AECOPD患者出现呼吸困难是由于潜在的PE引起。PE或其他静脉血栓疾病患者合并COPD时死亡率是未合并COPD者的两倍。PE的临床表现如呼吸困难、心动过速、胸膜疼痛等均为非特异性。COPD患者的急性呼吸困难诊断困难,典型表现如发热、咳痰、喘息等提示病情急性加重,当缺乏这些症状时,需要进一步检查以寻找潜在的病因。COPD可以导致多种心肺疾病如PE等病情加重,或者掩盖PE的症状。由于PE和AECOPD的症状较多重叠且都没有特异性,因此难以通过临床特征来发现COPD患者是否患有PE。COPD患者常常有肺部通气和血流灌注的缺损,导致无创的影像学检查技术诊断PE的特异性较低。近来随着增强CT的应用,现在诊断COPD患者是否合并PE的方法则可以将风险和不适降至最小。感染诱发的COPD急性加重可以通过有效的抗生素及皮质激素等治疗得以缓解,而血栓栓塞诱发的急性加重则需要有效的抗凝治疗,导致治疗时间延长,并且预后较差。对AECOPD患者必须考虑到PE的可能,因为未经治疗的PE患者死亡率可以高达25%。对于确诊的COPD患者,必须有明确的影像学证据发现血栓的存在,才能开始抗血栓治疗。该综述描述了COPD患者并发PE时的临床特征,并针对诊断和治疗做了较全面的阐述。
Other AbstractThe chronic obstructive pulmonary disease (COPD) is a major health burden worldwide. It is the fourth-leading cause of mortality, accounting for 3 million deaths annually. By 2020, COPD will be the third-leading cause of death, trailing only ischemic heart disease and stroke. Most COPD-related deaths occur during periods of exacerbation. Studies estimate that 50% to 70% of all acute exacerbations of COPD (AECOPD) are precipitated by an infectious process, while 10% are due to environmental pollution. Up to 30% of exacerbations are caused by an unknown etiology. Since venous thromboembolic (VTE) events can lead to cough and dyspnea, Pulmonary embolism (PE) may be another common cause of AECOPD. It is suspected that 25% patients with atypical COPD exacerbation may have PE as an underlying or concomitant cause of acute dyspnea. Patients with COPD have approximately twice the risk of PE and other VTE than those without COPD. The presentation of PE is similarly subtle with nonspecific clinical features such as acute dyspnea, tachycardia, and pleuritic chest pain. COPD patients presenting with acute dyspnea can be a diagnostic challenge. Typical features of fever, productive cough, and wheezing on presentation support COPD exacerbation, while absence of such findings may warrant further evaluation for underlying etiologies. Many cardiopulmonary diseases, including PE, are worsened or masked by the presence of COPD. There are no proven clinical criteria to help delineate PE from COPD. This is attributable to the overlap and nonspecificity of clinical features common to both diseases. Owing to multiple perfusion and ventilation abnormalities frequently observed in COPD lungs, noninvasive diagnosis of PE using imaging modalities was a significant challenge until quite recently. With the advent of contrast enhanced CT, it is now possible to reliably diagnose PE in COPD subjects with minimal discomfort or risk to the patients. However, dissimilar to infectious etiologies, which are effectively treated by antimicrobialsand systemic corticosteroids, thromboembolic diseases require anticoagulant therapy and significant delays in treatment are associated with poor outcomes. The mortality of untreated PE may be as high as 25%, so it is crucial to incorporate PE into the differential diagnosis of an AECOPD. While COPD remains a clinical diagnosis, PE requires objective confirmation of clot by an imaging study to warrant appropriate anticoagulati...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223570
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
柳彦涛. 肺栓塞与慢性阻塞性肺疾病[D]. 兰州. 兰州大学,2010.
Files in This Item:
There are no files associated with this item.
Related Services
Recommend this item
Bookmark
Usage statistics
Export to Endnote
Altmetrics Score
Google Scholar
Similar articles in Google Scholar
[柳彦涛]'s Articles
Baidu academic
Similar articles in Baidu academic
[柳彦涛]'s Articles
Bing Scholar
Similar articles in Bing Scholar
[柳彦涛]'s Articles
Terms of Use
No data!
Social Bookmark/Share
No comment.
Items in the repository are protected by copyright, with all rights reserved, unless otherwise indicated.