Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
JAMA. 2013 Jan 9;309(2):171-80. doi: 10.1001/jama.2012.164493.
The US Surgeon General estimates that 100,000 to 180,000 deaths occur annually from acute pulmonary embolism (PE) in the United States. The case of Ms A, a 60-year-old woman with acute PE and right ventricular dysfunction (submassive PE), illustrates the clinical challenge of identifying this high-risk patient population and determining when more aggressive immediate therapy should be pursued in addition to standard anticoagulation. The clinical examination, electrocardiogram, cardiac biomarkers, chest computed tomography, and echocardiography can be used to risk stratify patients with acute PE. Current options for more aggressive intervention in the treatment of patients with acute PE who are at increased risk of an adverse clinical course include systemic fibrinolysis, pharmacomechanical catheter-directed therapy, surgical pulmonary embolectomy, and inferior vena cava filter insertion. Determination of the optimal duration of anticoagulation and lifestyle modification to reduce overall cardiovascular risk are critical components of the long-term therapy of patients with acute PE.
美国外科医生估计，每年有 10 万至 18 万人死于美国的急性肺栓塞（PE）。A 女士的病例，一位 60 岁的急性 PE 和右心室功能障碍（亚大块 PE）患者，说明了识别这种高危人群并确定何时应除标准抗凝外更积极地进行即时治疗的临床挑战。临床检查、心电图、心脏生物标志物、胸部计算机断层扫描和超声心动图可用于对急性 PE 患者进行风险分层。对于急性 PE 风险较高的患者，更积极的治疗选择包括全身溶栓、药物机械导管定向治疗、肺动脉血栓切除术和下腔静脉滤器插入。确定抗凝治疗的最佳持续时间和生活方式改变以降低整体心血管风险是急性 PE 患者长期治疗的关键组成部分。
