1、昆明医科大学附属延安医院暨云南心血管病医院心内科薛强病史简介患者,男,48岁,因“反复劳力性气促、乏力10月余”入院。患者自诉近10月余活动后即感气促、乏力,伴胸闷、心悸,曾在外院就诊行CT、 肺动脉造影确诊“肺动静脉瘘” 。既往高血压 、脑梗塞、反复TIA。查体:BP128/86mmHg,发绀、杵状指,右侧肢体活动轻度受限检查DDR: 右肺中野见一类圆形密度均匀大小约5.5cm6.5cm影UCG:左心房内径增大,室间隔与左室后壁增厚动脉血气分析:PH:7.434,PO2:53.3mmHg,PCO2:33.5mmH,SO2:87.8%血生化:UA:565umol/l、TG:2.53mmol/L
2、血常规:RBC:5.531012/L、Hb:163g/L造影常规预封堵术后评估胸部CT:右肺下叶交界区见一高密度团块影,约5.2x4.0cm大小,边缘清楚,平扫CT值约15-90HU,其与右肺上动脉相连,相连端见封堵器存留,增强扫描病变呈明显不均匀强化,其内可见部分血栓形成,各叶、段支气管未见阻塞中断征象;MIP、MPR直观显示上述征象动脉血气分析: PH:7.318,PO2 76.1mmHg,PCO2:31.5mmHg,SO2:93.4%讨论封堵位置远端&近端封堵材料选择弹簧圈明胶海绵可脱卸球囊封堵器:Plug、各种Amplatzer封堵伞讨论抗凝或抗栓众说纷纭并发症适应症术中操作y#nye
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