人工瓣膜血栓诊断与治疗ppt课件

LOGO人工瓣膜血栓诊断与治疗1LOGO汇报内容人工瓣膜血栓的形成人工瓣膜血栓的诊断人工瓣膜血栓的治疗总结溶栓治疗2LOGO人工瓣膜血栓的形成v人工瓣膜血栓是瓣膜置换术后的严重并发症之一。 发生率： 10%/年 发达国家： 0.3%-1.3% 发展中国家： 6.1% 机械瓣（主动脉瓣 +二尖瓣）：0.5%-8% 机械瓣（三尖瓣）： 20% 生物瓣： 0.03%Gursoy Mo. et al. The current status of fluoroscopy and echocardiography in the diagnosis of prosthetic valve thrombosisa review article. Echocardiography. 2015, 32: 156-1643LOGO人工瓣膜血栓形成的高危因素怀孕抗凝不足心室功能障碍多个瓣膜置换房颤左房增大高危Gursoy Mo. et al. The current status of fluoroscopy and echocardiography in the diagnosis of prosthetic valve thrombosisa review article. Echocardiography. 2015, 32: 156-164 4LOGO人工瓣膜血栓的危害F.M. Castilho et al. Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta-analysis. J thromb Haemost , 2014, 12:1218-285LOGO人工瓣膜血栓的评估和管理呼吸困难、栓塞事件二尖瓣 /主动脉瓣 三尖瓣 /肺动脉2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease 级 ：患者有心脏病，但日常活动量不受限制，一般体力活动不引起 过度疲劳 、心悸、气喘或心绞痛。 级 ：心脏病患者的体力活动轻度受限制。休息时无自觉症状，一般体力活动引起过度疲劳、心悸、气喘或心绞痛。 级 ：患者有心脏病，以致体力活动明显受限制。休息时无症状，但小于一般体力活动即可引起过度疲劳、心悸、气喘或心绞痛。 级 ：心脏病患者不能从事任何体力活动，休息状态下也出现心衰症状，体力活动后加重 。经胸彩超经食道彩超6LOGO左侧血栓的治疗策略1. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease2. 2012 ACCP-9:Antithrombotic and Thrombolytic Therapy for Valvular Disease3. 2012 ESC/EACTS Guidelines on the management of valvular heart disease 7LOGO人工瓣膜血栓的治疗2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease8LOGO溶栓方案1. Raymond et al. Fibrinolysis of Mechanical Prosthetic Valve Thrombosis A Single-Center Study of 127 Case. JACC, 2003, 41(4): 653-8 2. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease9LOGO溶栓的疗程G. Karthikeyan el at. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis. 2011, 32: 146-149 10LOGO溶栓效果的评价Ganasan Karthikeyan, et al. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies. Eurpean Heart Journal, 2013, 34:1557-1566经胸彩超 X线透视11LOGO抗凝SK、 UK or rt-PA: fibrinolytic therapy is successfullIntravenous UFH + VKA4-6hVKAArotic: 3.0-4.0Mitral: 3.5-4.5INR1. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease2. G. Karthikeyan el at. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis. 2011, 32: 146-149 12LOGO溶栓的禁忌症2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease13LOGO溶栓的并发症主要出血：颅内出血、外周出血等并发症系统性栓塞：TIA、卒中、非 CNS栓塞17.8%死亡F.M. Castilho et al. Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta-analysis. J thromb Haemost , 2014, 12:1218-28 14LOGO溶栓并发症的时间G. Karthikeyan el at. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis. 2011, 32: 146-149 15LOGO1 2 31. 人工瓣膜血栓是瓣膜置换术后严重的并发症。2. 抗凝不足是其主要原因。3. 加强患者用药教育尤为重要。1. 对怀疑为人工瓣膜血栓的应尽早使用 TTE、 TEE进行诊断。2. 人工瓣膜血栓治疗方案的选择主要根据血栓大小