Goldhaber S Z
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Chest. 1991 Apr;99(4 Suppl):173S-179S. doi: 10.1378/chest.99.4.173s.
During the past year, there have been 2 major advances in the management of pulmonary embolism (PE). First, the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) investigators published the results of their comparison of ventilation-perfusion lung scanning and pulmonary angiography. This multimillion-dollar trial sponsored by the National Heart, Lung, and Blood Institute indicated that lung scanning is surprisingly insensitive to the diagnosis of PE. High-probability lung scanning detects fewer than half of the cases of PE that are found at pulmonary angiography. The PIOPED results force us to conclude that increased utilization of both ultrasonography of the deep leg veins and pulmonary angiography is warranted in order to detect the majority of cases of venous thromboembolism. Second, in June 1990, the Food and Drug Administration approved recombinant human tissue-type plasminogen activator (rt-PA) for use in the treatment of acute PE. The dosing regimen is 100 mg of rt-PA as a continuous peripheral intravenous infusion administered over 2 h. The convenience, rapid effect, and relative safety of this therapeutic approach may result in increased use of thrombolysis for management of PE.
在过去一年中，肺栓塞（PE）的治疗取得了两项重大进展。首先，肺栓塞诊断前瞻性研究（PIOPED）的研究人员公布了他们对通气-灌注肺扫描与肺血管造影进行比较的结果。这项由美国国立心肺血液研究所资助的耗资数百万美元的试验表明，肺扫描对PE诊断的敏感性出人意料地低。高概率肺扫描检测出的PE病例不到肺血管造影所发现病例的一半。PIOPED的结果迫使我们得出结论，为了检测出大多数静脉血栓栓塞病例，有必要增加下肢深静脉超声检查和肺血管造影的使用。其次，1990年6月，美国食品药品监督管理局批准重组人组织型纤溶酶原激活剂（rt-PA）用于治疗急性PE。给药方案是100mg rt-PA通过外周静脉持续输注2小时。这种治疗方法的便利性、快速起效和相对安全性可能会导致溶栓治疗在PE管理中的使用增加。
