Chan Wai-Ling, McLean Richard, Carolan Martin G
Department of Nuclear Medicine, Wollongong Hospital, New South Wales, Australia.
Australas Radiol. 2002 Dec;46(4):375-80. doi: 10.1046/j.1440-1673.2002.01087.x.
Pulmonary embolism (PE) remains a common preventable cause of death in hospitalized patients. The purpose of this study is to examine the in-hospital management, complications of treatment and clinical outcomes of inpatients undergoing lung scintigraphy for the diagnosis of PE in a regional hospital. Two hundred consecutive inpatients with suspected PE were enrolled. The results of lung scans, stratified according to the probability of pulmonary embolism, were correlated with anticoagulation status, discharge diagnosis, haemorrhagic complications and clinical outcome at 6 months. The use of complementary imaging investigations was also determined. Other imaging was performed infrequently (Doppler ultrasound in 18% of patients, CT pulmonary angiography (CT-PA) in 0.5% and conventional pulmonary angiography in 4% of patients). Long-term anticoagulation was initiated in 66 patients (33%), including 10 with intermediate probability lung scans (IPLS) who had no further investigations. Major haemorrhage occurred in 14% of all long-term anticoagulated patients followed up. The recognized recurrence rate was very low (3%) and there was no documented mortality from PE. Most patients with suspected PE are treated on the basis of the lung scan result without further tests. However, other imaging (especially CT-PA and conventional pulmonary angiography) should be performed prior to anticoagulation in patients with IPLS in whom the diagnosis is in doubt. Standard anticoagulation for 6 months appears to be effective for PE, and the recurrence rate is low. However, it has a significant risk of major haemorrhagic complications.
肺栓塞（PE）仍是住院患者中常见的可预防死因。本研究旨在探讨一家地区医院中接受肺闪烁显像以诊断PE的住院患者的院内管理、治疗并发症及临床结局。连续纳入200例疑似PE的住院患者。根据肺栓塞可能性分层的肺部扫描结果与抗凝状态、出院诊断、出血并发症及6个月时的临床结局相关。还确定了补充影像学检查的使用情况。其他影像学检查使用较少（18%的患者进行了多普勒超声检查，0.5%的患者进行了CT肺动脉造影（CT-PA），4%的患者进行了传统肺动脉造影）。66例患者（33%）开始长期抗凝治疗，其中包括10例肺部扫描为中度可能性（IPLS）且未进行进一步检查的患者。在所有接受长期抗凝治疗并随访的患者中，14%发生了大出血。公认的复发率非常低（3%），且没有PE导致的记录在案的死亡病例。大多数疑似PE的患者根据肺部扫描结果进行治疗，无需进一步检查。然而，对于诊断存疑的IPLS患者，在抗凝治疗前应进行其他影像学检查（尤其是CT-PA和传统肺动脉造影）。标准抗凝治疗6个月似乎对PE有效，且复发率较低。然而，它有发生严重出血并发症的显著风险。
