急性肺栓塞危险分层的研究进展

急性肺栓塞的严重程度可从无症状偶然发现的肺动脉亚段血栓至并发心源性休克和多脏器衰竭的高危肺栓塞。因此,迅速准确危险分层对确保高质量的治疗至关重要。本文对当今临床广泛使用和正在进行研究的急性肺栓塞危险分层评估方法给予综述,并讨论危险评估策略对肺栓塞优化治疗所起的作用。     

急性肺栓塞患者血浆心肌酶的变化及其对预后的评估价值

由于急性肺栓塞右室功能不全患者病死率较高,因而超声心动图检查被作为肺栓塞危险分层和预后评估的手段。由于许多医院不具备床旁超声心动图的检测条件,寻找一个能简单评估肺栓塞危险分层和预后的指标十分必要。本研究观察了急性肺栓塞患者血浆肌钙蛋白(cTnI)、肌酸激酶(CK-MB)     

心率变异性和心律失常对急性肺栓塞预后的评估价值

目的 探讨心率变异性(heart rate variability,HRV)和心律失常发生率对急性肺栓塞(acute pulmonary embolism,APE)危险分层及预后评估的临床价值.方法 回顾性分析100例经影像学检查确诊APE患者的临床资料.根据临床表现、简化肺栓塞严重指数、右心室功能不全和心肌损伤标志物...     

肺栓塞预后评估方法研究进展

<正>肺栓塞(PE)是以各种栓子阻塞肺动脉或其分支为发病原因的一组疾病或临床综合征的总称,其中肺血栓栓塞症(PTE)为肺栓塞的最常见类型[1]。急性肺栓塞可发生猝死,而长期慢性肺栓塞最终可能导致慢性右心衰竭,严重影响患者的后期生活质量。因其症状与体征不典型,临床上存在一定漏诊及误诊率。因此,及早评估肺栓塞严重程度并判断其预后,对于筛选不同危险分层的患者、给予相应治疗、改善预后、降低其经济负担至关重要。本文将主要从临床评分及实验室指标两方面,对     

肌钙蛋白I检测对急性肺栓塞患者的诊断和预后评估价值

急性肺栓塞(APE)发病率和病死率高,同时漏诊率和误诊率亦较高,能对APE进行快速的危险分层诊断和预后评估对指导临床治疗相当重要.研究表明肌钙蛋白I可用于APE的危险分层诊断,并可作为APE的独立预后评估指标,且检查方法简单、快捷、经济,其在APE患者诊治中的临床价值越来越受到重视.     

解读2008ESC急性肺栓塞诊断治疗指南——危险分层及诊断策略

2008年欧洲心脏病协会（ESC）颁布了新的急性肺栓塞（PE）诊治指南,该指南与ESC2000年指南相比,主要在危险分层、诊断方法、预后评估以及治疗等方面进行了更新。本文主要针对新指南中PE危险分层及诊断策略进行解读。     

红细胞分布宽度在急性肺栓塞中的研究进展

急性肺栓塞是仅次于高血压和冠心病的第三大临床上常见的心血管疾病,具有临床表现复杂、病死率高的特点.快速准确地诊断以及对其进行危险分层,选择出合适的治疗方案决定着肺栓塞的预后.近年来,红细胞分布宽度在急性肺栓塞的诊断、危险分层及其预后中成为研究热点.本文通过分析国内外有关红细胞分布宽度与急性肺栓塞的研究,从红细胞分布宽度对急性肺栓塞的诊断、危险分层及预后和红细胞分布宽度在急性肺栓塞中升高的机制3个方面作简要综述,为临床医师提供更全面、可靠的参考,并为进一步的研究寻找方向.     

急性肺栓塞常用危险分层评估研究进展

急性肺栓塞（APE）发病率逐年上升,但缺乏临床特异性症状及体征。一旦确诊APE,对患者进行早期危险分层并采取对应的治疗措施,可显著改善患者临床预后。本文就目前常用的几种APE危险分层评估工具进行综述,为临床诊疗与后续研究提供一定理论依据和思路。     

肌钙蛋白Ⅰ检测对急性肺栓塞患者的诊断和预后评估价值

急性肺栓塞(APE)发病率和病死率高,同时漏诊率和误诊率亦较高,能对APE进行快速的危险分层诊断和预后评估对指导临床治疗相当重要。研究表明肌钙蛋白Ⅰ可用于APE的危险分层诊断,并可作为APE的独立预后评估指标,且检查方法简单、快捷、经济,其在APE患者诊治中的临床价值越来越受到重视。     

心脏超声估测肺动脉压对于评估肺栓塞预后的作用

目的 探讨多普勒超声估测肺动脉压力对于评估肺栓塞预后的作用.方法 对66例肺动脉栓塞住院患者进行回顾性分析.根据2008年欧洲心脏病协会颁布的急性肺栓塞诊治指南对肺栓塞患者进行危险分层,根据心脏多普勒超声检查,对于存在三尖瓣反流的患者估测肺动脉收缩压,＞40 mm Hg为肺动脉高压组,≤40 mm Hg为肺动脉压正常组.比较两组间临床指标和危险分层的差异.结果 肺动脉收缩压与肺栓塞患者的危险度分层关系密切(P＜0.05),肺动脉高压组的氨基端前脑钠肽值较肺动脉压正常组明显增高(P＜0.01),但其肌钙蛋白T值与肺动脉压正常组相比差异无统计学意义(P＞0.05).结论 多普勒超声估测肺动脉压力对于肺栓塞预后有一定的评估意义.     

生物标记物在急性肺栓塞的风险评估中的作用

肺栓塞的临床谱较广,病情的轻重直接决定患者的预后和治疗决策的选择,因此对急性肺栓塞进行危险分层显得尤为重要.本文对几种生物标记物在肺栓塞风险分层中的作用作一综述.     

Apport de l’angioscanner pulmonaire dans l’évaluation de la gravité de l’embolie pulmonaire aiguë

Chest CT angiography has taken a major role in the management of patients with suspected pulmonary embolism. Meanwhile, it became necessary to determine the severity criteria at the time of diagnosis in order to properly assess the risk/benefit of treatment to consider. In recent years, pulmonary CT angiography has emerged as a useful tool for assessing the severity of acute lung embolism, based on morphological criteria. The two main approaches that were studied were the quantification of obstruction of pulmonary arterial bed and recognition of signs of right heart failure. The aim of our work is to define the morphological parameters in cardiovascular pulmonary CT angiography and to determine their value in the current clinical prognostic stratification of acute pulmonary embolism of, especially their correlation with the risk of developing signs of clinical severity at diagnosis and at 3 months of the occurrence of pulmonary embolism.     

心电图在肺栓塞严重程度评估中的作用

急性肺栓塞（APE）有较高的发病率和死亡率。因此,对APE患者早期、快速的诊断及危险分层尤为重要。心电图（ECG）反映了APE肺动脉高压引起的一系列病理生理过程,ECG改变与APE患者肺灌注缺损程度、右心室收缩功能、住院期间出现严重并发症有很好的相关性。本文对ECG各种波形改变及DanielECG评分与肺栓塞严重程度之间的相关性进行了综述,旨在增强大家对ECG在肺栓塞危险分层中价值的了解。     

Acute pulmonary embolism: risk stratification in the emergency department

Pulmonary embolism is a common disease associated with a high mortality rate. Death due to pulmonary embolism occurs more commonly in undiagnosed patients before hospital admission or during the initial in-hospital stay. Thus, mortality could be reduced by prompt diagnosis, early prognostic stratification and more intensive treatment in patients with adverse prognosis. Mortality is particularly high in patients with pulmonary embolism presenting with arterial hypotension or cardiogenic shock. In patients with pulmonary embolism and normal blood pressure, a number of clinical features and objective findings have been associated with a high risk of adverse in-hospital outcome. Advanced age and concomitant cardiopulmonary disease are clinical risk factors for in-hospital mortality. The Bburden of thromboembolism, as assessed by lung scan or spiral CT, and right ventricle overload, as assessed by echocardiography and probably spiral CT, have been claimed to be risk factors for in-hospital mortality. Elevated serum levels of troponins have been shown to be associated with right ventricular overload and adverse in-hospital outcomes in patients with pulmonary embolism. Despite the currently available evidence, no definite prognostic value can be assigned to any of the individual risk factors or cluster of them. Large prospective trials should be carried out to validate individual risk factors or clusters of risk factors able to identify patients with acute pulmonary embolism at high risk for in-hospital mortality. These patients could afford the trade-off of an increased risk of side effects related to a more aggressive treatment, such as thrombolysis or surgical or interventional procedures.     

New guidelines for the diagnosis and management of pulmonary embolism:Key changes

Pulmonary embolism (PE) is an important public health problem. In August2019, the European Society of Cardiology in collaboration with the European Respiratory Society released new guidelines for the diagnosis and management of PE. We discuss the basic changes between these recent guidelines and the previous guidelines that were published in 2014. Regarding diagnosis, the new guidelines propose the use of an age-adjusted cut-off level of D-dimers instead of a fixed cut-off value. A D-dimer test adapted to clinical possibility should also be considered instead of fixed cut-off level of D-dimer. Detailed recommendations for the diagnosis of PE during pregnancy are also provided. Regarding risk stratification, assessment of PE-related early mortality risk is recommended.Moreover, the importance of right ventricular dysfunction is emphasized in lowrisk patients. For further risk stratification of the severity of PE in patients without hemodynamic instability, use of validated scores that combine clinical,imaging and laboratory PE-related prognostic factors might also be considered.Regarding treatment, the possibility of early discharge is mentioned in patients without severe comorbidities, who are not of high risk for sudden death and in whom proper medical management at home and proper medical follow up can be ensured. The new guidelines also suggest that pro-brain natriuretic peptide levels, right ventricular function and the presence of thrombus in the right heart could be useful for guiding the decision of early discharge. Overall, these new guidelines introduce several key changes and knowledge and adherence to them will improve the outcome of patients with PE.     

Risk stratification of patients with acute symptomatic pulmonary embolism

Patients with acute symptomatic pulmonary embolism (PE) who present with arterial hypotension or shock have a high risk of death (high-risk PE), and treatment guidelines recommend strong consideration of thrombolysis in this setting. For normotensive patients diagnosed with PE, risk stratification should aim to differentiate the group of patients deemed as having a low risk for early complications (all-cause mortality, recurrent venous thromboembolism, and major bleeding) (low-risk PE) from the group of patients at higher risk for PE-related complications (intermediate-high risk PE), so low-risk patients could undergo consideration of early outpatient treatment of PE and intermediate-high risk patients would undergo close observation and consideration of thrombolysis. Clinicians should also use risk stratification and eligibility criteria to identify a third group of patients that should not undergo escalated or home therapy (intermediate-low risk PE). Such patients should initiate standard therapy of PE while in the hospital. Clinical models [e.g., Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI)] may accurately identify those at low risk of dying shortly after the diagnosis of PE. For identification of intermediate-high risk patients with acute PE, studies have validated predictive models that use a combination of clinical, laboratory and imaging variables.     

Pulmonary embolism,part I: Epidemiology,risk factors and risk stratification,pathophysiology, clinical presentation,diagnosis and nonthrombotic pulmonary embolism

Pulmonary embolism is an important clinical entity with considerable mortality despite advances in diagnosis and treatment. In the present article, the authors offer a comprehensive review focused mainly on epidemiology, risk factors, risk stratification, pathophysiological considerations and clinical presentation. Diagnosis based on assessment of clinical likelihood, electrocardiography, chest x-ray, D-dimer levels, markers of myocardial injury and overload, and blood gases is discussed in detail. Special attention is devoted to the clinical use of computed tomography, pulmonary angiography and echocardiography in the setting of pulmonary embolism.     

危险分层对肺栓塞管理策略的指导价值

急性肺栓塞(APE)的病情严重程度影响患者的预后和死亡风险,依据病情进行风险评估可以指导临床决策.初始危险分层是根据血流动力学不稳定的临床症状和体征进行的,这些症状和体征可反映APE早期的高死亡风险.在血流动力学稳定的APE患者中,需要进一步进行(高级)风险评估,细化的危险分层和预后评估可以协助临床更合理和精准地管理患...