Schmidt B, Schellong S
Universitäts-Gefässzentrum C.G. Carus, TU Dresden, Germany.
Internist (Berl). 2005 Aug;46(8):899-909, quiz 910-1. doi: 10.1007/s00108-005-1422-9.
Venous thromboembolism is often triggered by transient episodes of increased risk but may occur spontaneously in patients with permanently increased risk. Pulmonary embolism may cause impairment of respiratory and circulatory function which can vary in severity from silent to catastrophic. The diagnosis can be feasibly established by detecting vein thrombosis. If this approach fails, demonstration of pulmonary emboli by lung scans becomes necessary to establish the diagnosis. A D-dimer-test can select patients in whom imaging of pulmonary perfusion is required. Immediate therapeutic anticoagulation with heparins is mandatory in confirmed thromboembolism, and is followed by a vitamin K antagonist. In the initial work-up, patients also have to be evaluated for systemic thrombolytic therapy by hemodynamic parameters and echocardiography. In a triggered episode of venous thromboembolism, duration of anticoagulation is confined to several months while spontaneous or recurrent events require prolonged or indefinite treatment.
静脉血栓栓塞通常由风险短暂增加的发作引发，但在风险持续增加的患者中也可能自发发生。肺栓塞可能导致呼吸和循环功能受损，其严重程度从无症状到灾难性不等。通过检测静脉血栓形成可合理地确立诊断。如果这种方法失败，通过肺部扫描显示肺栓塞对于确立诊断就变得必要。D - 二聚体检测可筛选出需要进行肺灌注成像的患者。对于确诊的血栓栓塞，立即使用肝素进行治疗性抗凝是必需的，随后使用维生素K拮抗剂。在初始检查中，还必须通过血流动力学参数和超声心动图对患者进行全身溶栓治疗评估。在静脉血栓栓塞的触发发作中，抗凝持续时间限于数月，而自发或复发性事件则需要延长或无限期治疗。
