上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (1): 106-.doi: 10.3969/j.issn.1674-8115.2019.01.021

• 病例报告 • 上一篇    

D-二聚体正常肺栓塞病例的诊断与治疗分析 1例

张义芹 1，谢松铭 2，王文安 1   

  1. 1. 上海交通大学医学院附属新华医院崇明分院神经内科，上海 202150；2. 山东省泰安市中医医院脑病外科，泰安 271000
  • 出版日期:2019-01-28 发布日期:2019-02-27
  • 通讯作者: 王文安，电子信箱：13611641232@163.com。
  • 作者简介:张义芹（1974—），女，主治医师，博士生；电子信箱：tazyq4561233@126.com。

Diagnosis and treatment of a case of pulmonary embolism with normal D-dimer

ZHANG Yi-qin1, XIE Song-ming2, WANG Wen-an1   

  1. 1. Department of Neurology, Chongming Branch, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China; 2. Department of Brain Surgery, Traditional Chinese Medicine Hospital of Taian City, Shandong Province, Taian 271000, China
  • Online:2019-01-28 Published:2019-02-27

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摘要： 患者为 51岁女性，因“反复抽搐 1月”入院，查体未见明显神经系统阳性体征，多次检测 D-二聚体均在正常范围，脑部 CT、脑电图等检查提示无明显异常。患者入院时出现持续低氧血症，遂行肺动脉灌注 CT成像检查，结果示双侧肺动脉主干远端及各主要分支见血管充盈缺损，部分管腔狭窄闭塞，双侧肺动脉小分支可见广泛类似充盈缺损，最终确诊为肺栓塞。患者经华法林抗凝治疗后病情稳定。

关键词: 肺栓塞, D-二聚体, 诊断, 治疗

Abstract:

The patient was a 51-year-old female. She was admitted to the hospital becaof “repetitive convulsions for 1 month”. No significant neurological positive signs were found in the examination. D-dimer was in the normal range in several times of detection. Brain CT and electroencephalograph showed no obvious abnormality. Sustained hypoxemia occurred on admission, and CT imaging of pulmonary artery perfusion was performed. In the CT images bilateral distal main pulmonary arteries and their main branches showed vessel filling defect, partial lumen stenosis and occlusion, and bilateral small branches of pulmonary arteries showed extensive similar filling defect. Finally the patient was diagnosed with pulmonary embolism, whose condition was safter anticoagulation therapy with warfarin.

Key words: pulmonary embolism, D-dimer, diagnosis, treatment

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