Internal illnesses. Pulmonary embolism (PTE) (most important)

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Internal illnesses. Pulmonary embolism (PTE) (most important)

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32. THROMBOEMBOLISM OF THE PULMONARY ARTERY (PE)

Blockage of the arterial bed of the lung by a thrombus formed in the venous system, right atrium, ventricle of the heart, or other material that has entered these areas.

Etiology. Venous thrombus (in 85% of cases the source is in the inferior vena cava system, much less often in the right chambers of the heart and veins of the upper extremities) - drops of fat, tumor cells, air, parasites, foreign bodies.

Risk factors include advanced age, atherosclerosis, the presence of malignant tumors, pregnancy, contraceptives, obesity, varicose veins.

Pathogenesis. The triad of R. Virchow is characteristic: slowing down the speed of blood flow, increasing blood clotting, damage to the vascular wall.

Classification. The disease is divided

1) downstream: acute, subacute, recurrent;

2) according to the affected area: small (up to 25% of the volume of the switched off channel), submassive (up to 26-50%), massive (up to 51-75%), lethal (more than 75%);

3) according to the severity of manifestations.

Clinic. The main syndromes are: pulmonary-pleural (bronchospasm, shortness of breath, cough, hemoptysis, pleural friction noise, pleural effusion), cardiac (retrosternal pain, tachycardia, accent II tone, systolic and diastolic murmurs over the pulmonary artery, pericardial friction murmur, hypotension , swelling of the cervical veins, cyanosis), abdominal (pain in the right upper quadrant of the abdomen), cerebral (loss of consciousness, convulsions, paresis), renal (anuria).

According to the significance and degree of manifestations, the symptoms are distributed in the following sequence: tachycardia, chest pain, shortness of breath, hemoptysis, fever, moist rales, cyanosis, cough, pleural friction noise, collapse.

Diagnostic study. A sputum examination and a study of the blood coagulation system are carried out (moderate hypercoagulation, increased levels of platelet b-thromboglobulin and decreased antithrombin III). ECG: tachycardia, deviations of the atrial and ventricular vectors to the right, transient blockade of the right bundle branch. X-ray examination: expansion of the lung root, diffuse depletion of the pulmonary pattern. Perfusion scintigraphy is indicated (registration of radiation over the lungs after intravenous administration of a colloidal solution of protein labeled with technetium) - with PE, a decrease in radiation.

Flow. Associated with the risk of death.

Treatment. In acute PE at stage I, an urgent intravenous administration of 10-000 IU of heparin is performed, sedatives, analgesics are prescribed, and oxygen is given. At the II stage, streptokinase (15 IU intravenously drip), vasoactive drugs, antiacidotic therapy, heparin administration (000-250 IU 000 times a day under control of blood coagulation) are indicated. At the III stage, an embolectomy is performed - in the absence of the effect of the I and II stages of treatment and no later than 5000 hours from the onset of the disease.

For recurrent pulmonary embolism, long-term use of indirect anticoagulants (6-12 months) is indicated.

Prevention Timely treatment of the threatened contingent, reduction in the amount of animal fats and cholesterol in food.

Author: Myshkina A.K.

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