中危肺血栓栓塞症的诊断依据与临床意义

Intermediate risky pulmonary thromboembolism:diagnostic criteria and clinical significance

中危肺血栓栓塞症(PTE)概念的界定、诊断标准以及潜在临床意义在临床实践中至关重要。对选择性的中危PTE患者,尤其是对于伴有临床不良预后表现,即新出现的血流动力学不稳定、呼吸困难加重、严重的右心功能不良抑或是大面积心肌损害合并较低出血风险的患者进行溶栓治疗;而对于低危PTE或是中危PTE患者伴有轻度右心功能不良,或没有临床症状加重的患者不推荐溶栓治疗。但如何评价中危PTE患者预后,以及如何对中危患者进行分层,则仍需要大样本随机对照研究(RCT)研究。

The definition, diagnostic criteria and clinical significance of intermediate risk pulmonary thromboembolism （PTE） are very important for clinical practise. Tbrombolysis may be considered for patients with intermediate risky PTE judged to have clinical evidence of adverse prognosis （ hemodynamic instability, worsening resp. insufficiency, severe RV dysfunction, or major myocardial necrosis） and low risk of bleeding complications. Thrombolysis is not recommended for patients with intermediate risky PE with only mild right heart dysfunction and low risk PTE. Large scare randomized clinical trial（RCT） is awaited for the evaluation of prognosis and risk stratification for submassive PTE.