危险分层对肺栓塞管理策略的指导价值

Guiding value of risk stratification for management strategy of pulmonary embolism

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者。2018-04中华医学会呼吸病学分会和中国医师协会呼吸医师分会联合发布的《肺血栓栓塞症诊治与预防指南》以及2019年欧洲呼吸学会(ERS)和欧洲心脏学会(ESC)联合发布的《急性肺栓塞诊断和管理指南》,进一步确定了危险分层在临床实践中的决策作用。该文基于上述指南和相关研究进展,对危险分层和预后评估在肺栓塞临床决策中的作用进行综述。

The severity of acute pulmonary embolism(APE)affects the prognosis and death risk of the patients.Risk stratification based on the patients′conditions can guide clinical decision-making.The initial risk stratification is based on the clinical symptoms and signs of hemodynamic instability.These symptoms and signs indicate a high risk of death in the early stage of APE.In APE patients with stable hemodynamics,further(advanced)risk assessment is needed.Detailed risk stratification and prognosis assessment can help to manage the patients more reasonably and accurately.The Guidelines for Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism jointly issued by the Chinese Thoracic Society and the Chinese Association of Chest Physicians in April 2018 and 2019 the European Society of Cardiology(ESC)Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism developed in collaboration with the European Respiratory Society(ERS)further determine the decision-making role of risk stratification in clinical practice.Based on the above guidelines and related research progress,this paper reviews the role of risk stratification and prognosis assessment in clinical decision-making of pulmonary embolism.