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1、【摘要】hl的探討肺動(dòng)脈栓塞(PE)合并腦動(dòng)脈栓塞的診斷與治療方法。方法回顧性分析2007年10月至2011年7月廈門人學(xué)附屬屮山醫(yī)院5例肺動(dòng)脈栓塞合并腦動(dòng)脈栓塞的臨床資料，并復(fù)習(xí)有關(guān)文獻(xiàn)。結(jié)果5例患者均為女性，平均年齡為46.5歲，均通過增強(qiáng)肺部CT及肺ECT證實(shí)為肺動(dòng)脈栓塞，經(jīng)超聲心動(dòng)圖檢查發(fā)現(xiàn)均有中-重度肺動(dòng)脈高壓，2例卵圓孔未閉，1例為先天性房間隔缺損。5例患者均經(jīng)頭部MRI診斷為新發(fā)腦楝死。3例采用溶栓治療，5例均給予抗凝治療。5例患者經(jīng)治療均存活，且長期服用華發(fā)令，INR控制在2.0?2.5Z間，1例患者腦栓塞3d后再次出現(xiàn)腦栓塞，4例患者隨訪未再次發(fā)生體循環(huán)系統(tǒng)栓塞。結(jié)論矛盾
2、性腦栓塞并非少見，應(yīng)加強(qiáng)診斷意識(shí)。對(duì)于肺動(dòng)脈栓塞，尤其是肺動(dòng)脈高壓合并體循壞動(dòng)脈栓塞或不明原因的腦動(dòng)脈栓塞，應(yīng)考慮到才盾性栓塞可能。【關(guān)鍵詞】肺動(dòng)脈栓塞；矛盾性腦栓塞；診斷ClinicalanalysisofparadoxicalcerebralembolismfrompulmonaryembolismGEHua,ZHENGWei-hong,WANGYong-jian,ZHURen-jing.DepartmentofNeurology,ZhongshanHospitalXiamenUniversity,Xiamen361004,ChinaCorrespondingauthor：ZHENGW
3、ei-hong,Email：gehua701121@163.com[Abstract]ObjectiveToexplorethediagnosisandtreatmentofcerebralembolismfrompulmonaryembolism(PE).MethodsTheclinicaldataof5caseswithPEaccompaniedbycerebralembolismcoveringaperiodfromOctoberof2007toJulyof2011wereretrospectivelyanalyzed.ResultsInthisstudy,theaverageage
4、of5cases(allfemale)was46.5yearsold?PEwasdiagnosedthroughenhancedCTandECTinlungamongal15cases?Moderatetoseverepulmonaryhypertcnsionwasconfirmedbyechocardiogram?Twocaseswaspatentforamenovaleandonewascongenitalatrialseptaldefect?EachpatientwasdiagnosedtobenewonsetcerebralinfarctionbyMRT.Threecasesund
5、erwentcerebralarterialthrombolysis.Allofthemsurvivedandlong-termanticoagulanttreatmentwithWarfarin.INRwasadjustedbetween2.0and2?5bychangeofWarfarindose.Amongthem,onepatienthadcerebralembolismagainjust3daysafterthelatestcerebralembolism；theother4patientsdidnotsufferfromcerebralembolismduringthefoll
6、ow-up.ConclusionsParadoxicalcerebralembolismiscommon.ForclinicalpatientswithPE,especiallypulmonaryhypertensionaccompaniedbysystemiccirculationarterialembolismorunexplainedsystemiccerebralarterialembolism,paradoxicalcerebralembolismshouldbeconsidered?[Keywords】Pulmonaryembolism；Paradoxicalcerebrale
7、mbolism；Diagnosis肺動(dòng)脈栓塞癥(肺栓塞)并發(fā)矛盾性腦栓塞并不常見，而且臨床醫(yī)師對(duì)其認(rèn)識(shí)不足，故具i吳診和漏診率頗高。矛盾性栓塞的病例國內(nèi)有所報(bào)道[1],但單純報(bào)道肺動(dòng)脈梗塞致才盾性腦栓塞較少，現(xiàn)回顧性分析廈門大學(xué)附屬中山醫(yī)院近年收治5例才盾性腦栓塞患者的臨床資料并復(fù)習(xí)冇關(guān)文獻(xiàn)，旨在提高臨床醫(yī)師對(duì)矛盾性栓塞的認(rèn)識(shí)，減少誤診和漏診。1資料與方法1.1一般資料所有研究對(duì)彖為2007年10刀至2011年7月廈門大
