Leuchte H H, Behr J
Medizinische Klinik I, Klinikum Grosshadern, LMU München.
MMW Fortschr Med. 2003 May 15;145(20):39-43.
In suspected acute pulmonary embolism, the measurement of the d-dimer is now an established screening method. Further diagnostic measures include the electrocardiogram, echocardiography and conventional chest radiography, as well as the analysis of blood gases. The specific demonstration of a pulmonary embolism is achieved with a helical CT of the thorax, pulmonary angiography and ventilation/perfusion scanning. Apart from continuous (infusion) of unfractionated heparin, the low molecular weight heparins also are of potential value in the treatment of pulmonary embolism. A larger percentage of patients benefit from the use of fibrinolytic agents than was previously thought, so that the indication for fibrinolytic therapy should not be made dependent on the presence of hemodynamic instability.
在疑似急性肺栓塞时，D - 二聚体检测现已成为一种既定的筛查方法。进一步的诊断措施包括心电图、超声心动图和传统胸部X线摄影，以及血气分析。通过胸部螺旋CT、肺血管造影和通气/灌注扫描可实现肺栓塞的特异性诊断。除了持续（静脉输注）普通肝素外，低分子肝素在肺栓塞治疗中也具有潜在价值。受益于使用纤溶药物的患者比例比以前认为的要高，因此纤溶治疗的指征不应取决于血流动力学不稳定的存在。
