1、流行病学 发病率逐渐升高 美国500/百万，日本62/百万2006年，围手术期4.41-2.79，女性发病率增高较快，好发年龄60-70岁。危险因素 Interrupted blood flow 长期卧床 肥胖 怀孕 心肺疾病 (如充血性心力衰竭、慢性肺心病等) 全麻 下肢麻醉 下肢制动 下肢静脉曲张 Endothelial dysfunction 手术 外伤、骨折 中心静脉置管 导管介入检查或治疗 血管炎 抗磷脂综合症 Hyperhomocysteinemia（高同型半胱氨酸血症，遗传或获得性） Hypercoagulability 恶性肿瘤 怀孕 手术、创伤、骨折 烧伤 药物 (如口服避孕
2、药、雌激素等) 感染 肾病综合征 炎性肠病 骨髓增生性疾病，红细胞增多症 阵发性睡眠型血红蛋 抗磷脂综合症 抗 蛋 C 蛋 S 蛋 制因 增多血 素 蛋 C 抗 血 因 (G20210A)*症 、 征 性 、 型床 动、currency1 或 “ fifl 血流动力学 心 检查心”增fl心 、 心 、 、血或 （ 90或较 血下等40） 性肺 Start heparin therapy when pulmonary embolism is suspected. Examine for deep vein thrombosis at once. *1Screen the patient with
3、 chest X-ray, ECG, arterial blood gas analysis, transthoracic echocardiography, and blood chemistry. *2When PCPS is not available, maintain circulation with cardiac compressionand vasopressors. CT, computed tomography; PCPS, percutaneous cardiopulmonary support. Adapted from Therapeutic Research 200
4、9; 30: 744 747.*1 When risk of bleeding is high. *2 Treat complications appropriately with available methods.*3 Unstable hemodynamics consistent with shock or prolonged hypotension.*4 Condition requiring cardiopulmonary resuscitation or prolonged severe shock.*5 Consider PCPS according to hospital e
5、quipments and patient condition.*6 Select appropriate treatment according to hospital equipments and patient condition.*7 Evaluate based on right ventricular enlargement on echocardiography and severity of pulmonary hypertension.*8 Presence/absence of DVT which may have serious effects if it release
6、s emboli causing recurrent embolism. The above algorithm is an example.Each institution should select appropriate methods according to its healthcare resources. DVT, deep vein thrombosis;PCPS, percutaneous cardiopulmonary support; IVC, inferior vena cava.素抗 素 5,000 units静 , 1,400 units/hr . 6hr APTT
7、 ， *1Use this table for APTT reagents with a therapeutic range of 1.9 to 2.7 times the control. *2 When unfractionated heparin is administered at a concentration 40 units/mL. APTT, activated partial thromboplastin time; Bolus, bolus dose for repeated administration; Hold, duration of suspension of continuous infusion; Rate change, change in infusion rate during continuous infusion; Dose change, change in dose during continuous infusion.
