欧洲泌尿外科协会(EAU)发布2010年版ED及PE诊疗指南

EAU近日在其官方网站发布最新版的勃起功能障碍(Erectile dysfuntion)和早泄(Premature ejaculation)的诊疗指南。新版的诊疗指南和2008年版本相比,没有太大的变化,ED的一线药物仍然为PDE5抑制剂:sildenafil(西地那非), tadalafil(他达拉非)和 vardenafil(伐地那非)。欧洲泌尿外科协会官方网站可下载该指南的免费全文

EAU近日在其官方网站发布最新版的勃起功能障碍(Erectile dysfuntion)和早泄(Premature ejaculation)的诊疗指南。新版的诊疗指南和2008年版本相比,没有太大的变化,ED的一线药物仍然为PDE5抑制剂:sildenafil(西地那非), tadalafil(他达拉非)和 vardenafil(伐地那非)。

CONTEXT: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions. OBJECTIVE: To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE. EVIDENCE ACQUISITION: A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: ED is highly prevalent, and 5-20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient’s complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis. PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal. CONCLUSIONS: These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site

欧洲泌尿外科协会官方网站可下载该指南的免费全文,下载地址 :http://www.uroweb.org/nc/professional-resources/guidelines/online

肺栓塞(pulmonary embolism)的心电图表现

急性肺栓塞(pulmonary embolism,PE)指内源性或外源性栓子堵塞肺动脉或其分支引起肺循环障碍导致的临床和病理生理综合征。PE大多来源于深静脉血栓形成(deep venous thrombosis,DVT),临床上可以无任何症状,或偶然发现血栓,也可因严重栓塞引起猝死。急性肺栓塞在欧美等国家是一种常见病,发病率、病死率均很高.西方国家总人群PE年发生率约为0.5‰,美国每年新发PE 65万~70万人,其死亡率仅次于冠心病及肿瘤居人口死因构成第三位。

急性肺栓塞

急性肺栓塞(pulmonary embolism,PE)指内源性或外源性栓子堵塞肺动脉或其分支引起肺循环障碍导致的临床和病理生理综合征。PE大多来源于深静脉血栓形成(deep venous thrombosis DVT),临床上可以无任何症状,或偶然发现血栓,也可因严重栓塞引起猝死。急性肺栓塞在欧美等国家是一种常见病,发病率、病死率均很高.西方国家总人群PE年发生率约为0.5‰,美国每年新发PE 65万~70万人,其死亡率仅次于冠心病及肿瘤居人口死因构成第三位。

急性肺栓塞是手术术后最危险的并发症之一,除了来源于深静脉的血栓外,在骨科也可发生脂肪栓塞,而在妇产科,羊水栓塞则较为常见。

急性肺栓塞的心电图表现包括SIQⅢTⅢ;完全或不完全性右束支传导阻滞;V1-V3T波倒置等,但急性肺栓塞心电图表现常为一过性及多变性,常需动态观察。典型的急性肺栓塞心电图表现见图:

急性肺栓塞的心电图表现

急性肺栓塞如果出现较为典型的心电图表现,一般提示栓塞较严重,抢救极为困难。此外,若患者出现晕厥也是提示患者栓塞面积较大,病情危重。