肺栓塞合并矛盾栓塞致大面积脑梗死一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

韩文雅 ¹ , 陈沛沛 ¹ , 肖传勇 ¹ , 庹亚鑫 ² , 张婷 ¹ , 任涛 ¹ , 刘玉全 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; 卵圆孔未闭

DOI：

10.7507/1671-6205.202312052

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目的分析肺栓塞合并矛盾栓塞的病例特点，提高临床医生对矛盾栓塞的认识，减少误诊、漏诊，对该疾病做到早发现、早诊断、早治疗，降低患者的死亡风险。方法在“知网数据库”及“万方数据库”检索1998—2023年肺栓塞合并矛盾栓塞的文献，结合十堰市太和医院收治的1例患者，汇总分析相关临床资料。结果肺栓塞合并矛盾栓塞患者共99例，其中91例为临床诊断病例，8例为尸检确诊病例。其中男51例，女48例，年龄15～77岁。矛盾栓塞最常见部位为脑47例（47.5%），其次是四肢动脉18例（18.2%），肾脏11例（11.1%）。右向左分流的通路主要为卵圆孔未闭。91例临床诊断病例中，13例（14.3%）患者死亡。结论面对肺栓塞/静脉血栓栓塞患者及反复发生动脉栓塞的患者，应警惕卵圆孔未闭等因素存在造成矛盾栓塞的可能，诊疗过程中应密切关注患者病情变化，更加仔细询问相关病史，加强筛查，减少漏诊、误诊，降低患者死亡风险。

Citation： 韩文雅, 陈沛沛, 肖传勇, 庹亚鑫, 张婷, 任涛, 刘玉全, 王梅芳. 肺栓塞合并矛盾栓塞致大面积脑梗死一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(7): 509-514. doi: 10.7507/1671-6205.202312052 Copy

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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.	蒋德雄, 王廷杰, 王红军, 等. 肺栓塞合并矛盾性栓塞国内文献分析: 附一例报告. 中国呼吸与危重监护杂志, 2012, 11(6): 588-591.
10.	秦绪常, 姚珠峰, 邢利峰. 急性肺栓塞合并卵圆孔未闭致院内缺血性脑卒中1例. 临床急诊杂志, 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.	李贺智, 何亚峰, 王琦光, 等. 卵圆孔未闭超声心动图及右心声学造影临床操作规范. 中国实用内科杂志, 2022, 42(5): 376-380.
13.	李越, 翟亚楠, 魏丽群, 等. 经食管与经胸超声心动图造影检出卵圆孔未闭右向左分流效果比较. 中华医学超声杂志(电子版), 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. Stöllberger 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. 卢楠, 钟优, 何青. 矛盾栓塞患病现状与思考. 中国心血管杂志, 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. 蒋德雄, 王廷杰, 王红军, 等. 肺栓塞合并矛盾性栓塞国内文献分析: 附一例报告. 中国呼吸与危重监护杂志, 2012, 11(6): 588-591.
10. 秦绪常, 姚珠峰, 邢利峰. 急性肺栓塞合并卵圆孔未闭致院内缺血性脑卒中1例. 临床急诊杂志, 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. 李贺智, 何亚峰, 王琦光, 等. 卵圆孔未闭超声心动图及右心声学造影临床操作规范. 中国实用内科杂志, 2022, 42(5): 376-380.
13. 李越, 翟亚楠, 魏丽群, 等. 经食管与经胸超声心动图造影检出卵圆孔未闭右向左分流效果比较. 中华医学超声杂志(电子版), 2013, 10(11): 44-48.

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