Sakuma Masahito, Okada Osamu, Nakamura Mashio, Nakanishi Norifumi, Miyahara Yoshiyuki, Yamada Norikazu, Fujioka Hirofumi, Kuriyama Takayuki, Kunieda Takeyoshi, Sugimoto Tsuneaki, Nakano Takeshi, Shirato Kunio
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai.
Intern Med. 2003 Jun;42(6):470-6. doi: 10.2169/internalmedicine.42.470.
There are many reports on the diagnosis and management of acute pulmonary embolism (APE), but there have been no investigations concerning the actual conditions in which recent developments in diagnostic imaging techniques and therapies have been applied in clinical practice. The present study was designed to investigate the changes in diagnostic imaging techniques and therapies for APE.
Three hundred and nine APE patients diagnosed during January 1994-October 1997 (Group 1) were compared with 257 APE patients diagnosed during November 1997-October 2000 (Group 2) in terms of the diagnostic imaging techniques and therapies for APE.
Compared with Group 1, pulmonary angiography and contrast-enhanced computed tomography were more frequently performed for diagnosis in Group 2 [45.3% vs 56.8% (p = 0.0069) and 13.9% vs 57.6% (p < 0.0001), respectively]. Heparin and vena cava filter were used more often in Group 2 [74.4% vs 82.1% (p = 0.033) and 18.4% vs 33.9% (p < 0.0001), respectively]. The frequency of thrombolytic therapy was unchanged between the two groups. Warfarin use in discharged patients increased from 71.9% to 83.8% (p = 0.0022). However, the examination rates for deep vein thrombosis (DVT) were low (60.8% in Group 1 and 65.4% in Group 2, p = 0.29) and unchanged using any imaging techniques.
The diagnostic imaging techniques for APE increased in variety and the management has improved, while the diagnosis for DVT remains unchanged.
关于急性肺栓塞（APE）的诊断和治疗已有很多报道，但尚未有研究关注诊断成像技术和治疗方法的最新进展在临床实践中的实际应用情况。本研究旨在调查APE诊断成像技术和治疗方法的变化。
将1994年1月至1997年10月诊断的309例APE患者（第1组）与1997年11月至2000年10月诊断的257例APE患者（第2组）在APE诊断成像技术和治疗方法方面进行比较。
与第1组相比，第2组中用于诊断的肺动脉造影和增强计算机断层扫描更为频繁[分别为45.3%对56.8%（p = 0.0069）和13.9%对57.6%（p < 0.0001）]。第2组更常使用肝素和腔静脉滤器[分别为74.4%对82.1%（p = 0.033）和18.4%对33.9%（p < 0.0001）]。两组间溶栓治疗的频率没有变化。出院患者中使用华法林的比例从71.9%增加到83.8%（p = 0.0022）。然而，深静脉血栓形成（DVT）的检查率较低（第1组为60.8%，第2组为65.4%，p = 0.29），并且使用任何成像技术时该比例均未改变。
APE的诊断成像技术种类增加，治疗方法有所改进，而DVT的诊断情况未变。
