肺栓塞合并矛盾栓塞致大面積腦梗死一例并文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

韓文雅 ¹ , 陳沛沛 ¹ , 肖傳勇 ¹ , 庹亞鑫 ² , 張婷 ¹ , 任濤 ¹ , 劉玉全 ³ ,  王梅芳 ¹

1. ;
2. ;
3. ;

Corresponding?author：

王梅芳, Email: wmfpps02@hotmail.com

Keywords：

肺栓塞; 矛盾栓塞; 卵圓孔未閉

DOI：

10.7507/1671-6205.202312052

Video：

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目的分析肺栓塞合并矛盾栓塞的病例特點，提高臨床醫生對矛盾栓塞的認識，減少誤診、漏診，對該疾病做到早發現、早診斷、早治療，降低患者的死亡風險。方法在“知網數據庫”及“萬方數據庫”檢索1998—2023年肺栓塞合并矛盾栓塞的文獻，結合十堰市太和醫院收治的1例患者，匯總分析相關臨床資料。結果肺栓塞合并矛盾栓塞患者共99例，其中91例為臨床診斷病例，8例為尸檢確診病例。其中男51例，女48例，年齡15～77歲。矛盾栓塞最常見部位為腦47例（47.5%），其次是四肢動脈18例（18.2%），腎臟11例（11.1%）。右向左分流的通路主要為卵圓孔未閉。91例臨床診斷病例中，13例（14.3%）患者死亡。結論面對肺栓塞/靜脈血栓栓塞患者及反復發生動脈栓塞的患者，應警惕卵圓孔未閉等因素存在造成矛盾栓塞的可能，診療過程中應密切關注患者病情變化，更加仔細詢問相關病史，加強篩查，減少漏診、誤診，降低患者死亡風險。

Citation： 韓文雅, 陳沛沛, 肖傳勇, 庹亞鑫, 張婷, 任濤, 劉玉全, 王梅芳. 肺栓塞合并矛盾栓塞致大面積腦梗死一例并文獻復習. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(7): 509-514. doi: 10.7507/1671-6205.202312052 Copy

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7.	盧楠, 鐘優, 何青. 矛盾栓塞患病現狀與思考. 中國心血管雜志, 2019, 24(2): 202-205.
8.	Yu Z, Deng H, Wang J, et al. Paradoxical embolism after surgery for breast cancer: a case report. BMC Surg, 2020, 20(1): 148.
9.	蔣德雄, 王廷杰, 王紅軍, 等. 肺栓塞合并矛盾性栓塞國內文獻分析: 附一例報告. 中國呼吸與危重監護雜志, 2012, 11(6): 588-591.
10.	秦緒常, 姚珠峰, 邢利峰. 急性肺栓塞合并卵圓孔未閉致院內缺血性腦卒中1例. 臨床急診雜志, 2020, 21(7): 587-589.
11.	Nagarajarao H, Ojha C, Kedar A, et al. Patent foramen ovale, the role of antiplatelet therapy alone or anticoagulant therapy alone versus device closure for cryptogenic stroke: a review of the literature and current recommendations. Cardiovasc Hematol Agents Med Chem, 2020, 18(2): 135-150.
12.	李賀智, 何亞峰, 王琦光, 等. 卵圓孔未閉超聲心動圖及右心聲學造影臨床操作規范. 中國實用內科雜志, 2022, 42(5): 376-380.
13.	李越, 翟亞楠, 魏麗群, 等. 經食管與經胸超聲心動圖造影檢出卵圓孔未閉右向左分流效果比較. 中華醫學超聲雜志(電子版), 2013, 10(11): 44-48.

1. Turetz M, Sideris A, Friedman O, et al. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Semin Intervent Radiol, 2018, 35(2): 92-98.
2. Windecker S, Stortecky S, Meier B. Paradoxical embolism. J Am Coll Cardiol, 2014, 64(4): 403-415.
3. St?llberger C, Slany J, Schuster I, et al. The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism. Ann Intern Med, 1993, 119(6): 461-465.
4. Myers P, Bounameaux H, Panos A, et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest, 2010, 137(1): 164-170.
5. Meacham R, Headley A, Bronze M, et al. Impending paradoxical embolism. Arch Intern Med, 1998, 158(5): 438-448.
6. Hara H, Virmani R, Ladich E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol, 2005, 46(9): 1768-1776.
7. 盧楠, 鐘優, 何青. 矛盾栓塞患病現狀與思考. 中國心血管雜志, 2019, 24(2): 202-205.
8. Yu Z, Deng H, Wang J, et al. Paradoxical embolism after surgery for breast cancer: a case report. BMC Surg, 2020, 20(1): 148.
9. 蔣德雄, 王廷杰, 王紅軍, 等. 肺栓塞合并矛盾性栓塞國內文獻分析: 附一例報告. 中國呼吸與危重監護雜志, 2012, 11(6): 588-591.
10. 秦緒常, 姚珠峰, 邢利峰. 急性肺栓塞合并卵圓孔未閉致院內缺血性腦卒中1例. 臨床急診雜志, 2020, 21(7): 587-589.
11. Nagarajarao H, Ojha C, Kedar A, et al. Patent foramen ovale, the role of antiplatelet therapy alone or anticoagulant therapy alone versus device closure for cryptogenic stroke: a review of the literature and current recommendations. Cardiovasc Hematol Agents Med Chem, 2020, 18(2): 135-150.
12. 李賀智, 何亞峰, 王琦光, 等. 卵圓孔未閉超聲心動圖及右心聲學造影臨床操作規范. 中國實用內科雜志, 2022, 42(5): 376-380.
13. 李越, 翟亞楠, 魏麗群, 等. 經食管與經胸超聲心動圖造影檢出卵圓孔未閉右向左分流效果比較. 中華醫學超聲雜志(電子版), 2013, 10(11): 44-48.

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