Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Nat Rev Cardiol. 2010 Oct;7(10):585-96. doi: 10.1038/nrcardio.2010.106. Epub 2010 Jul 20.
Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the other. Only around 1 in 5 individuals with suspected PE will have the diagnosis confirmed, therefore, the diagnostic work-up for PE should comprise safe, efficient, and noninvasive methods. The first step in the approach to diagnosis of patients with suspected PE is to determine the clinical probability and to perform a D-dimer test. PE can be excluded in patients with a 'low', 'intermediate' or 'unlikely' clinical probability and a normal D-dimer test. Additional imaging is required for those with a 'high' or 'likely' clinical probability or a positive D-dimer test. CT pulmonary angiography or ventilation-perfusion scintigraphy, followed by additional testing is the next step when test results are nondiagnostic. Although various diagnostic strategies have been introduced and validated, selected patients may require a tailored approach.
肺栓塞（PE）是一种常见的急性且可能致命的疾病。已经确定了许多 PE 的遗传和获得性风险因素。为了预防与 PE 相关的发病率和死亡率，同时避免不必要的治疗，充分的诊断是必要的。只有大约 5 分之一的疑似 PE 患者的诊断会得到确认，因此，PE 的诊断性检查应包括安全、有效和非侵入性的方法。诊断疑似 PE 患者的方法的第一步是确定临床可能性，并进行 D-二聚体测试。对于临床可能性“低”、“中”或“不太可能”以及 D-二聚体测试正常的患者，可以排除 PE。对于临床可能性“高”或“很可能”或 D-二聚体测试阳性的患者，需要进行额外的影像学检查。当检查结果不具有诊断性时，下一步是进行 CT 肺动脉造影或通气灌注闪烁扫描，然后进行额外的检查。尽管已经引入并验证了各种诊断策略，但某些特定患者可能需要量身定制的方法。
