Department of Research, St. Mary Mercy Hospital, Livonia, MI 48154, USA.
Clin Appl Thromb Hemost. 2012 Jan-Feb;18(1):20-6. doi: 10.1177/1076029611422363. Epub 2011 Sep 23.
We assessed the potential safety of withholding treatment of pulmonary embolism (PE) limited to subsegmental branches. Literature review showed that untreated patients with mostly subsegmental PE had no fatal recurrences in 1 to 3 months and no nonfatal recurrences of PE in 3 months. Patients with suspected PE who had nondiagnostic ventilation/perfusion lung scans, adequate cardiorespiratory reserve or low or moderate clinical probability, and negative serial noninvasive leg tests were shown not to require treatment. It appears safe, therefore, to withhold treatment of subsegmental PE providing (1) pulmonary-respiratory reserve is good; (2) no evidence of deep venous thrombosis (DVT) on serial testing; (3) major risk factor for PE was transient and no longer present; (4) no history of central venous catheterization or atrial fibrillation; and (5) willingness to return for serial venous ultrasound. After fully informing patients, some may choose to be treated and some may choose not to be treated.
我们评估了仅对亚段分支的肺栓塞（PE）进行治疗的潜在安全性。文献综述显示，在 1 至 3 个月内，大多数亚段性 PE 未接受治疗的患者没有致命性复发，在 3 个月内没有非致命性 PE 复发。对于疑似 PE 患者，如果通气/灌注肺扫描无诊断价值、心肺储备充足或临床可能性低或中度，以及连续非侵入性下肢检查为阴性，则无需治疗。因此，对于亚段性 PE 患者，只要（1）肺呼吸储备良好；（2）连续检查无深静脉血栓形成（DVT）的证据；（3）PE 的主要危险因素是短暂的，且不再存在；（4）无中心静脉导管或心房颤动病史；以及（5）愿意进行连续静脉超声检查，那么不进行治疗似乎是安全的。在充分告知患者后，有些患者可能会选择治疗，有些患者可能会选择不治疗。
