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[急性血栓栓塞]

[Acute thromboembolism].

作者信息

Bloch K E

机构信息

Abteilung Pneumologie, Universitätsspital Zürich.

出版信息

Praxis (Bern 1994). 2004 Oct 6;93(41):1679-85. doi: 10.1024/0369-8394.93.41.1679.

Abstract

The diagnosis of acute pulmonary embolism is based on the assessment of risk factors, consistent symptoms and signs, and the lack of an alternative clinical explanation for the condition of the patient. If the probability of pulmonary embolism is low or intermediate, the diagnosis can be reliably excluded by a negative D-dimer test. A positive D-dimer test requires further evaluation by spiral angio computed tomography technique to confirm or rule out pulmonary embolism. The angiocoexisting pulmonary diseases. If the clinical probability for pulmonary embolism is high an angio-CT rather then a D-dimer should be performed at the first place. If there are signs of deep leg vein thrombosis, massive pulmonary embolism with hemodynamic instability and in other special circumstances the diagnostic approach has to be adapted accordingly. A timely diagnosis and treatment with heparin and oral anticoagulation significantly reduces the acute and chronic morbidity and mortality of pulmonary embolism.

摘要

急性肺栓塞的诊断基于对危险因素、相符的症状和体征的评估,以及缺乏对患者病情的其他合理解释。如果肺栓塞的可能性较低或为中度,D - 二聚体检测结果为阴性可可靠地排除诊断。D - 二聚体检测结果为阳性则需要通过螺旋血管计算机断层扫描技术进一步评估,以确认或排除肺栓塞。血管造影可发现并存的肺部疾病。如果肺栓塞的临床可能性较高,应首先进行血管造影CT而非D - 二聚体检测。如果有下肢深静脉血栓形成的迹象、伴有血流动力学不稳定的大面积肺栓塞以及其他特殊情况,诊断方法必须相应调整。及时使用肝素和口服抗凝剂进行诊断和治疗可显著降低肺栓塞的急性和慢性发病率及死亡率。

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