最后审阅: 3 十一月 2021
最后更新: 17 二月 2020

小结

定义

病史和体格检查

关键诊断因素

  • 呼吸困难
  • 胸痛
  • 合并深静脉血栓形成(concurrent deep vein thrombosis, DVT)的体征
  • 危险因素
  • 缺氧
  • 不符合肺栓塞排除标准(即 PERC 规则)
  • Wells(或 Geneva)评分结果呈阳性
  • 血流动力学不稳定或血流动力学储备严重减少的征象

危险因素

  • 年龄增长
  • 深静脉血栓形成 (DVT) 诊断
  • 肥胖 (BMI ≥29 kg/m²)
  • 近 2 个月内有手术史
  • 卧床休息>5 日
  • 既往有静脉血栓栓塞病史
  • 静脉血栓栓塞 (VTE) 家族史
  • 恶性肿瘤活跃期
  • 吸烟
  • 慢性阻塞性肺疾病 (COPD)
  • 有近期外伤或骨折病史
  • 充血性心力衰竭 (CHF)
  • 中心静脉置管
  • 妊娠/产后
  • 静脉曲张
  • 近期乘坐飞机旅行
  • 自然流产史
  • 近期急性心肌梗死
  • 脓毒症
  • 近期输血史
  • 复方激素避孕
  • 口服激素替代治疗 (HRT)
  • 下肢瘫痪
  • 炎症性肠病
  • 肾病综合征
  • 白塞病
  • 高同型半胱氨酸血症
  • 费城染色体阴性的骨髓增殖性肿瘤
  • 凝血因子 V Leiden 突变
  • 凝血酶原 G20210A 突变
  • 抗凝血酶缺乏
  • 蛋白 C 缺陷
  • 蛋白 S 缺陷
  • 抗磷脂抗体综合征

诊断性检查

首要检查

  • 计算机断层扫描肺动脉造影 (CTPA)
  • 超声心动图
  • D-二聚体
  • 全血细胞计数
  • 心电图(ECG)
  • 尿素和电解质
  • 凝血功能检查
  • 肝功能检测

需考虑的检查

  • 动脉血气 (ABG)
  • 胸部 X 线检查(CXR)
  • 下肢静脉加压超声
  • 心脏生物标志物
  • 通气与血流灌注比值 (V/Q) 扫描
  • 对无诱因 PE 的进一步检查

新兴检查

  • 生物标志物
  • 床旁 D-二聚体检测
  • 根据临床概率调整的 D-二聚体检测
  • 磁共振血管成像 (MRA)

治疗流程

撰稿人

专家顾问

Jonathan Bennett,

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

利益声明

JB is Chair, British Thoracic Society (unpaid). JB declares that he has no competing interests.

Richard Russell, MBBS, PhD, MRCP

Specialty Registrar in Respiratory Medicine

Glenfield Hospital

Leicester

UK

利益声明

RJR received sponsorship from AstraZeneca to attend a conference, May 2018 (covering travel, accommodation, and conference fee).

Onyeka Umerah,

Respiratory registrar

Glenfield Hospital

Leicester

UK

利益声明

Claire Vella,

Clinical fellow in lung cancer

Glenfield Hospital

Leicester

UK

利益声明

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Scott M. Stevens MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

Department of Internal Medicine

University of Utah

Salt Lake City

UT

Scott C. Woller MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Professor of Medicine

University of Utah

Salt Lake City

UT

Gabriel V. Fontaine PharmD, BCPS

Clinical Coordinator

Critical Care Pharmacy

Advanced Clinical Pharmacist

Neuroscience Critical Care

Intermountain Medical Center

Murray

UT

利益声明

SMS is an investigator for two investigator-initiated clinical trials for which his institution receives funds from Bristol-Myers Squibb to enrol patients. SCW holds two investigator-initiated grants from Bristol-Myers Squibb/Pfizer paid to his employer Intermountain Healthcare for which he receives no compensation. He has been invited to serve as co-chair of the American College of Chest Physicians guideline on antithrombotic therapy for venous thromboembolic disease (AT11) and serves as an invited panelist for the US Centers for Disease Control and Prevention venous thromboembolism risk assessment model systematic review and guidance panel. GVF receives consulting fees and honoraria from Portola Pharmaceuticals for clinical consulting and speaking engagements.

同行评议者

Catherine Free,

Consultant Respiratory Physician

Medical Director

George Eliot Hospital NHS Trust

Nuneaton

UK

利益声明

CF declares that she has no competing interests.

编辑

Annabel Sidwell,

Section Editor, BMJ Best Practice

利益声明

AS declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

利益声明

JH declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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