oscarglendwgn的部落格

台中50歲張姓工程師因得長時間坐在電腦前工作，動輒4、5個小時，近2周起身活動後總會覺得呼吸喘，到胸腔科檢查並無異常，然而喘不過氣情形越來越嚴重，改掛心臟內科門診，檢查後發現肺動脈竟有血栓塞住，所幸透過抗凝血藥物治療後，不再氣喘吁吁，醫師也提醒他：「賺錢有數，想要活，就要動！」

亞洲大學附屬醫院心臟內科主治醫師許楹奇表示，張先生本身患有慢性腎功能不全的狀況，平時都有定期追蹤治療，不過近2周來，無論是走路活動或跑步後，都特別容易覺得喘，詢問日常作息，發現患者因工作關係，經常一坐就是好幾小時才起身，透過心電圖和胸部電腦斷層檢查後，發現患者肺動脈一個很大的血栓塞住，若不立即處理，恐怕會猝死的危險。

經收治住院，採用抗凝血藥物溶解血栓治療一個星期後，張先生症狀逐漸改善，並成功出院，目前持續使用抗凝血藥物追蹤，醫師也特別告誡他避免久坐不動，最好每半小時就起身走一走，「要活就要多動」。

許楹奇指出，肺動脈栓塞是指肺動脈血管被來自下肢深部靜脈的栓子塞住，形成栓子的物質（見圖），包括固體、液體或空氣，一旦出現拴塞，會影響病患的呼吸交換，常見症狀為活動性呼吸急促、呼吸困難、胸痛、水腫、發紺等，故長期操作電腦者、乘坐長途飛機、火車者、長期臥床病患、手術後的病人等，都容易因下肢血液循環不良，引發肺動脈栓塞症狀。

許楹奇指出，因肺動脈栓塞的症狀與許多疾病類似，使得漏診比例高，故為確保呼吸急促是否與其他臟器受損相關，需進行多項檢查相互應證，包括胸部Ｘ光、心電圖、心臟超音波、肺血液灌流及氣體分佈檢查、胸部電腦斷層，及抽血檢驗動脈血和D-dimer數值是否升高等，才能找出元兇。

許楹奇說，傳統上會建議以口服抗凝血藥（如可邁汀）治療，而新一代的抗凝血藥物不但出血風險小，使用上也更為方便，不需抽血監控藥物濃度，也增加病患服用藥物的遵從性，若肺動脈栓塞危急生命時，可使用血栓溶血劑，或手術╱導管方式直接抽吸清除血栓。

許楹奇提醒，肺栓塞患者需長期進行抗凝血藥物治療，應避免跌倒、拔牙等容易出血的情形，拔牙應告知醫師服用藥物；出現不適症應及時就醫，以達早期發現、早期治療之效。

Taichung’s 50-year-old engineer named Zhang was sitting in front of the computer for a long time, and spent 4 or 5 hours. After nearly 2 weeks of getting up, he always felt breathing and had no abnormalities in the chest examination. The more serious, the heart medical clinic was changed. After the examination, the pulmonary artery was found to have thrombus. Fortunately, after treatment with anticoagulant drugs, it was no longer panting. The doctor also reminded him: "Make money, want to live, move!" "

Xu Yuqi, attending physician of Department of Cardiology, Affiliated Hospital of Asia University, said that Mr. Zhang himself has chronic renal insufficiency and usually has regular follow-up treatment. However, in the past 2 weeks, it is particularly easy to walk or run. I felt asthma, asked about daily routine, and found that because of the working relationship, the patient often took a few hours to get up. After the electrocardiogram and chest computerized tomography, I found that the patient’s pulmonary artery was blocked by a large thrombus. If it is not treated immediately, I am afraid it will die. danger.

After being admitted to hospital for treatment, the anticoagulant drug was used to dissolve the thrombus for one week. Mr. Zhang gradually improved his symptoms and was discharged from the hospital. He continued to use anticoagulant drugs for follow-up. The doctor also warned him to avoid sedentary, preferably every half hour. Just get up and walk, "If you want to live, you need to move more."

Xu Yuqi pointed out that pulmonary embolism refers to the pulmonary artery blood vessels being plugged by emboli from the deep veins of the lower extremities, forming substances (see figure), including solid, liquid or air. Once occlusion occurs, it will affect the patient's breathing. Exchange, common symptoms are active shortness of breath, dyspnea, chest pain, edema, cyanosis, etc., so long-term computer operators, long-haul aircraft, trainers, long-term bedridden patients, patients after surgery, etc., are prone to blood circulation in the lower extremities Poor, causing pulmonary embolism symptoms.

Xu Yuqi pointed out that because the symptoms of pulmonary embolism are similar to many diseases, the proportion of missed diagnosis is high. Therefore, in order to ensure whether the shortness of breath is related to the damage of other organs, multiple tests are required, including chest X-ray, electrocardiogram, and heart. Ultrasound, pulmonary blood perfusion and gas distribution examination, chest computerized tomography, and blood test to check whether arterial blood and D-dimer values ??are elevated, etc., in order to find out the culprit.

Xu Qiqi said that it is traditionally recommended to treat with oral anticoagulants (such as Kemaiting), and a new generation of anticoagulant drugs not only has a low risk of bleeding, but also is more convenient to use. It also increases the compliance of patients taking drugs. If the pulmonary artery embolism is critically life, thrombus hemolytic agents can be used, or surgically sputum catheters can be used to directly remove the thrombus.

Xu Yuqi reminded that patients with pulmonary embolism need long-term anticoagulant therapy, should avoid falling, tooth extraction and other easy bleeding, tooth extraction should inform the physician to take the drug; in case of discomfort should seek medical advice in time to achieve early detection, early treatment effect.

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