二聚体在血栓性疾病中的诊断课件.ppt

静脉血栓栓塞（ VTE）的诊断过程 高临床概率 怀疑 DVT or PE 采用适当的 影像学检查 低/中等 临床概率 阳性 No DVT/PE 阴性 Perform D-Dimer 弥散性血管内凝血 DIC DIC 可以被描述为机体的促凝血和纤维蛋白溶解之间的平衡被打破。 弥散性血管内凝血是多种原因致弥漫性微血管内血栓形成，继之因凝血因子及血小板被大量消耗及纤维蛋白溶解亢进而发生的出血综合征。 Clotting Lysing 动脉血栓形成 D-Dimer 水平升高常见于以下情况: 心肌梗死 中风 不稳定心绞痛 D-Dimer 也可作为动脉血栓的危险预报 动脉血栓形成 D-二聚体水平升高主要见于下述疾病： 心肌梗死(M.I.) 脑栓塞 不稳定性心绞痛 在中国心梗和缺血性卒中等疾病给社会和家庭带来了巨大的经济负担，也使得60岁以上男性平均预期寿命缩短8-12年。 D-Dimer在POCT设备中的应用 辽宁省收费标准 金标法：70元 谢谢！ 2013-07-01 * The third most common cardiovascular disease (after ischemic syndromes and stroke). VTE may be expressed as a condition known as deep vein thrombosis (DVT), which may further develop into a potentially fatal pulmonary embolism (PE) Shown angiogram of Pulmonary Embolism (autopsy) * DVT can be seen proximally - above the knee, or more commonly, distally, confined to the calf veins. Most PE are due to embolization from the proximal leg veins rather than the distal calf veins Note also, thrombus and P.E., * DVT = blood clot primarily formed deep in the lower-leg or thigh. Approx.. 1 per 1,000 people are affected which results in hospitalization of 5-7 days for therapy. Most patients (50%) are asymptomatic until the clot alters circulation such as a PE. Those that have symptoms are non specific making it difficult for early detection. * Preventative, diagnostic, and treatment approaches for DVT remain controversial. Since only about one third of patient’s who present with symptoms of DVT actually have the disease, and because physical exam is inadequate, a clinical suspicion of VTE should always be confirmed by objective tests.Venography is the gold standard for diagnosis of DVT but Compression Ultrasound is the initial test of choice because is is less invasive.(Shown in picture) * Pulmonary Embolism is a blood clot that becomes dislodged and enters the pulmonary (lung) circulation often resulting in severe consequences. It is a complication of DVT as PE is detected in about 50% of patients with documented DVT. It has an a