Jeannin L, Coudert B, Lacroix S, Reybet-Degat O
Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Trouhaude, Dijon.
Agressologie. 1991;32(1):39-41.
Pulmonary Embolism (EP) remains a major challenge for the physician, despite increasingly sophisticated investigations and efficient therapeutic programs. Many reasons explain persistent difficulties: the disorder crosses all specialties. A wide variety of clinical presentations has to be considered according to the size of the thrombus, the coexisting conditions ("predisposing factors") and the prior cardio pulmonary status. Major investigations include perfusion and ventilation lung scans, pulmonary angiography, invasive and non invasive investigations of the deep venous system. But obvious practical limitations exist; selection of the most suitable test includes severity of the present patient condition and risk of an early recurrence of EP; risk of the contemplated therapeutic procedure if the diagnosis of EP is confirmed; skillfulness required for the selected investigation. Angiography is mandatory if a substantial hemorrhagic risk exists, if massive EP is suspected, and if at risk treatment procedures are contemplated. In the other cases, and in the absence of significant pulmonary pathology, a lung perfusion scan is the advisable procedure; the diagnosis is excluded if the scan is normal. Previous or current significant pulmonary pathology requires angiography. However, proof of coexisting deep venous thrombosis is an alternative way to enhance the diagnosis in case of poor clinical conditions or other practical considerations.
尽管检查手段日益精密，治疗方案日趋高效，但肺栓塞（PE）对医生来说仍是一项重大挑战。造成这一持续难题的原因众多：该病症涉及所有专科领域。必须根据血栓大小、并存病症（“诱发因素”）以及先前的心肺状况来考虑多种临床表现。主要检查包括肺灌注和通气扫描、肺血管造影、深静脉系统的有创和无创检查。但明显存在实际限制；选择最合适的检查需考虑当前患者病情的严重程度以及肺栓塞早期复发的风险；如果确诊为肺栓塞，所考虑的治疗程序的风险；所选检查所需的技术熟练程度。如果存在大量出血风险、怀疑有大面积肺栓塞以及考虑有风险的治疗程序时，血管造影是必需的。在其他情况下，且不存在明显肺部病变时，肺灌注扫描是可取的程序；如果扫描结果正常，则可排除诊断。既往或当前存在明显肺部病变则需要进行血管造影。然而，在临床状况不佳或出于其他实际考虑的情况下，证明并存深静脉血栓形成是加强诊断的另一种方法。
