急性型から慢性肺血栓塞栓症性肺高血圧症に移行した1例
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- あきお かみこ
- 5 years ago
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1 Japanese Society of Pulmonary Embolism Research -JaSPER-
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21 MAA 1964 WagnerIio Iio ,1SD 99mTc MAA 81mKr discrete defectmpd MDP MPD MDP PH MPD MDP PH PH MDP patchinessmottled pattern /scan match CT /scan mismatch PIOPED
22 Acute Pulmonary EmbolismAPE Deep Vein ThrombosisDVT APE Doppler 1) a) b) c) 2) a) b) c) TEI (total ejection isovolmic) indextissue Doppler Imaging DVT
23 gold standard DSA perfusion defect CT perfusion CT multidetector row CT (DVT) proximal distal DVT MRI
24 CT CT CT 2, 4, 8, 16 CTMDCT Gold Standard CT Sensitivity 53100%Specificity 78100% MDCT Sensitivity 6792%Specificity 94100% CT CT CT 3 Multiplanar Reformation MPR CT 20 CT
25 1) 2) 1) 1) MRI MRA MRI MRI MRA MRI MRI T1 100 CT CT MRI MRI
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30 APTE APTE APTEP 17 APTE DVT N 38 APTE DVT APTE 3 5 APTE P N p= p= APTE DVT 2001 APTEDVT APTE APTEDVT
31 PTE PTE 4.41 / P P= / PTE 5 25 P PTE
32 Massive submassive 67 40mmHg bpm 12617mmHg 788mmHg 444mmHg mmHg 229mmHg 3 20% subacute acute on chronic
33 CT27.7 RI 5.2 MRI
34 2 169 NK/T cell lymphoma CT CT CT
35 148 H H CT
36 44 Burger 4 13 major tranquilizer CT 9 5 CT massive CT ) major tranquilizer 2)
37 (pulmonary thromboembolism: PTE) PTE PTE cm 56kg (III) (#2 50%#6 90%) 1 ICU FiO PaO mmhg X CT 3 PTE 1.5 / CT 24
38 t-pa /LPT 56.5%FDP70g/mL mmHg CO2 9mmHg SpO219% t-pa SpO2100% PaO2451mmHg SpO2 t-pa SpO2 96% CT t-pa
39 15 X PTE HCT PTE X PagetSchroetter
40 CT T4N3M1 Trousseau
41 149 CT PTE 4.6 HIT 15.7 PTE HIT 20.5 HIT HIT 2 HIT PF4 ELISA HIT HIT
42 mg/ 99 8 T CT BMI mg/ 03 5 CT mg/ mg/ 02 3 CT 2.5 /mm 3 11
43 CT 1mg/ 5 FU IIIaVF 1-2 CT CT 8 CT 17
44 (PE) DVT gold standard PE proximal DVT spiral CT compression US time-of-flight MR-venography 1.5Tesla MRI (GYROSCAN ACS- NT Powertrak 3000, Philips ) T2 balanced Turbo Field Echo (btfe) PE 3 DVT 8 workstation curved reformation (CR)
45 High intensity transient signals: HITS Doppler HITS HITS HITS HITS (HDI3000, 2-4MHz sector probe) HITS TC MHz HITS 4 HITS HITS HITS HITS HITS HITS
46 ) solublefibrinsf D-dimer DIC DVT PE DVT PE SF PE23 ( 6 17 ) DVT SF GE-XDPD-dimer TATPIC (2SD) g/mL g/mL D-dimer g/mL U/ ml /ml4.88.3u/ml SFD-dimer GE-XDP SF PE/DVT
47 UK CDT10 CDT+IPC 6 CDT UK100 CDT+IPC UK72 CDT CDT+IPC 3 6
48 (DVT) (PE) (47-86 ) 34DVT PE CT 180 PE 4 INR 2 TATPIC DD 1) DVT ( ) PE ) DVT ) DVT ) 2 DVT % PE % DVT PE 1) 2)
49 (DVT)5 2 DVT retrospective 3 (42.9%) 7 (100%) CT5 (71.4%) (71.4%) (100%)
50 APTE APTE ) ) ) APTE CT 50 AMPTE mmHg mmHg 1 4) APTE PTE
51 Massive pulmonary embolism embolectomy embolectomy / 4/ embolectomy 3 DM+postCABG, CTR 5460 PO2 PCO2 ECHO 3 CT PCPS 6 massive IVC filter NYHA Massive pulmonary embolism Massive pulmonary embolism
52 cpte 1020 cpte AT 1 lupus anti-coagulant PCPS 2 45mmHg 20mmHg warfarization PT INR NYHA 1 HOT 30 lupus anti-coagulant mmHg 20mmHg NYHA 3 10 HOT cpte
53 ( 56-84) 3 1 NYHA
54 (DVT) (IVC) 25 DVT 37 IVC 38 8 CT IVC IVC 10 DVT 37 IVC CT IVC 700mL 10 CT
55 (MODS) 54 2 MODS CTMRI 7 MRSA ARDS MODS IVC filter IVC filter
56 56 CT PTE mutant t-pa Swan-Ganz SG 1 SG mutant t-pa DVT PTE PTE DVT PTE 1
57 DVT PTE PTE DVT DVT D-dimer DVT, PTE CT D-dimer D-dime g/mL 20g/mL CT CT DVT,PTE 20g/mL CT DVT PTE 6 DVT 12 9 PTE 6 4 PTE, DVT CT 53 CT 26 PTE, DVT D-dimer D-dimer g/ml g/mld-dimer 4 CT CT20 PTE 1 DVT 1 22 PTE 5 11 DVT D-dimer DVT DVT CT CT
58 P-V (62 ) 2922mm Cine MRI risk IVC P-V P-V
59 /25(35)mmHg
60 (CPTE) 10 PCPS 20 PCPS CPTEAT- 40mmHg 763 PO2(Room Air)60.3mmHg CPTE PCPS PCPS 22 19mmHg 119 PO2(Room Air)97.2mmHg CPTE
61 X-p 6244mmHg 1995 CT g 6cm 15cm 8cm 10cm 6cm
62 , CPAOA massive PTE DVT PTE DVT DVTPTE DVTPTE 1 2 DVTPTE PTE DVTPTE
63 RII CT Virchow
64 (TEE) TEE TEE TcMAA TEE TEE TEE TEE
65 PE DVT 1986~2001 PE 11/10447( 0.11%, 27.3%, 2:9, 4.5 ) DVT 7/10447( 0.07%, 1:6, 12.4 ) PE 43 ISPC PE 3/ %, 0% DVT 2/ % PE PEDVT PE %1/1078, 0%DVT PEDVT ISPC
66 DVT ( PE) DVT PE :8 2 DVT 85 7 massive PE PT,TT,Fibirnogen 5 50 DVT 1 PE PE PTCA DVT 50 DVT PE Subclinical DVT PE
67 15 1
68 prospective 12.9% 29.0% heparin TM SPECT MDCT 3 1) 2)
69 (PTE) (IVC filter) IVC filter IVC filter ) 7 (18%)dislocation 6 (16%) 18 (47%) 2) dislocation 6 Zefon International K-Lok 1 dislocation mL/hr (48%vs47%) (37vs23%of filter area, p<0.05) IVC filter dislocation
70 (TF) TF TF 20 (DVT) TF TF TF DVT TF 3 4 TF CT DVT TF 25 2 DVT 2 DVT
71 CT
72 PTE t-ivc IVC t-ivc- t-ivc-f
73 in vitro 25mm 50cm Protect % 47mm 420mm 1.11g/cm 3 2.2L/min 25cm 7mm mm mm 12mm 67 4mm 8mm mm 100 4mm
74 risk group 140 Body Mass Index low risk group (LRG) high risk group (HRG) moderate risk group (MRG) Risk group LRG MRG HRG LRG 95.4%, MRG 3.5%, HRG1.1% 4246 LRG 95.0%, MRG 2.8%, HRG 2.2% HRG 1 HRG2 LRG1 LRG (7/9907 ) HRG 2.8(4/142 )
75 /3396=0.17% ACCP AHA
76 (TKA) (DVT) TKA TKA TKA DVT TKA DVT DVT
77 DVT SOCOS 5500 : Phlips 1) DVT 2) DVT DVT 3) DVT DVT 4) DVT DVT DVT DVT
78 8 (NMES)5 7
79 (PTE) CT CT PTE CT PTE 82 (APTE)59 (CPTE)23 APTE CPTE APTE CPTE APTE CPTE PTE PTE
80 (PE) CT CT angiography PE PE CT angiography 27 GE Hispeed ultra 1.25 mm mm 16 delay time Boyden (S: 0-40) (U) (O) (N) (I) S 16(6-27) 10 S 3(1-7) 21 U: 1% O: 4%N: 23%I: 72% U: 17 %O: 2 N: 7%I: 74% CT CT angiograpy
81 CT MRA 10 1) 2 2) 3) F 1.4mm CO2 5) FITC CTMRA
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83 CTEPH 9 retrospective tpa4 2 2 IVC 7 Beraprost 5 1 mpa mmHg mpa mmHg 4 8 IVC intervension CTEPH Beraprost
84 TEL FAX
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31 Venous thromboembolism VTE Deep vein thrombosis DVT VTE DVT DVT VTE VTE VTE VTE VTE VTE VTE VTE 31.1 VTE (Elastic stocking ES) (Intermittent pneuma
31 Venous thromboembolism VTE Deep vein thrombosis DVT VTE DVT DVT VTE VTE VTE VTE VTE VTE VTE VTE 31.1 VTE (Elastic stocking ES) (Intermittent pneumatic compression ICP) (Low dose unfractionated heparin
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