急性肺栓塞的诊疗进展

Diagnosis and Treatment Progress of Acute Pulmonary Embolism

肺栓塞是一种具有极高发病率、误诊率和死亡率的常见心血管疾病,早期诊断并积极开展治疗对急性肺栓塞患者的预后具有重要意义。动脉血气分析、心电图、超声心动图等方法对急性肺栓塞的诊断价值不大,多用于肺栓塞的初筛与预后评估,年龄校正后的D-二聚体、临床评分是目前应用最广、最便捷的筛查急性肺栓塞的方法。目前肺栓塞的确诊方法主要包括肺动脉计算机断层扫描血管成像、肺通气/灌注单光子发射计算机断层显像、肺动脉血管造影,其中肺动脉计算机断层扫描血管成像是诊断肺栓塞的首选检查。肺栓塞的治疗包括对症支持治疗、抗凝、溶栓、介入手术治疗,具体如何选择治疗方案需要结合患者的临床实际。

Pulmonary embolism is one of the most common cardiovascular diseases,which has a sky-high morbidity,misdiagnosis rate and mortality,and early diagnosis and active treatment are of great significance for improving the prognosis of patients with acute pulmonary embolism. Arterial blood gas analysis,electrocardiogram,eechocardiography,etc. have little value in the diagnosis of acute pulmonary embolism,while they are usually used in the screening and prognosis evaluation.Age-corrected D-dimer and clinical score are the most widely used and the most convenient screening methods for acute pulmonary embolism. Currently,the definite pulmonary embolism diagnosis methods mainly include computed tomographic pulmonary angiography,pulmonary ventilation/perfusion single photon emission tomography scanning and pulmonary artery angiography,of which pulmonary artery computed tomography angiography is the preferred examination. The treatment methods include symptomatic supportive therapy,anticoagulation,thrombolysis and interventional surgery. How to choose the treatment plan needs to be combined with the practical clinical situation of the patients.