From the Trauma Service, Scripps Mercy Hospital, San Diego, California.
J Trauma Acute Care Surg. 2014 May;76(5):1270-4. doi: 10.1097/TA.0000000000000233.
Pulmonary embolus (PE) is thought to arise from a deep venous thrombosis (DVT). Recent data suggest that PE can present without DVT, inferring that PE can originate de novo (DNPE). We examined the relationship between DVT and PE in trauma patients screened for DVT with duplex sonography (DS). We sought to validate the incidence of PE without evidence of DVT and to examine the clinical significance of this entity.
We reviewed the medical records of all trauma patients from July 2006 to December 2011 with PE who also had serial surveillance DS (groin to ankle). Demographics, severity of injury, interventions, signs and symptoms of PE, as well as chest computerized tomography findings were collected. Patients with no DS evidence of DVT either before or within 48 hours of PE diagnosis (DNPE) were compared with those with DVT (PE + DVT).
Of 11,330 patients evaluated by the trauma service, 2,881 patients received at least one DS. PE occurred in 31 of these patients (1.08%): 19 (61%) were DNPE, and 12 (39%) were PE + DVT. Compared with patients with PE + DVT, patients with DNPE were significantly younger and had more rib fractures, pulmonary contusions, infections, pulmonary symptoms, and peripherally located PEs on computerized tomography.
This is the first report of the clinical course of DNPE without embolic origin in a population with comprehensive duplex surveillance. In our series, DNPE seems to be more prevalent after trauma, to be clinically distinct from PE following DVT, and to likely represent a local response to injury or inflammation; however, further research is warranted to fully understand the pathophysiology of DNPE.
Care management study, level III.
肺栓塞（PE）被认为源于深静脉血栓形成（DVT）。最近的数据表明，PE 可在无 DVT 的情况下出现，这意味着 PE 可原发（DNPE）。我们检查了在接受双功能超声（DS）筛查 DVT 的创伤患者中 DVT 与 PE 之间的关系。我们旨在验证无 DVT 证据的 PE 的发生率，并检查这种情况的临床意义。
我们回顾了 2006 年 7 月至 2011 年 12 月间所有因 PE 而接受连续 DS（腹股沟至脚踝）监测的创伤患者的病历。收集了人口统计学资料、损伤严重程度、干预措施、PE 的体征和症状以及胸部计算机断层扫描结果。将无 DS 证据的患者（无论是在 PE 诊断前还是在 48 小时内）与有 DVT（PE + DVT）的患者进行比较。
在接受创伤科评估的 11330 名患者中，有 2881 名患者接受了至少一次 DS。在这些患者中有 31 例发生了 PE（1.08%）：19 例（61%）为 DNPE，12 例（39%）为 PE + DVT。与 PE + DVT 患者相比，DNPE 患者明显更年轻，肋骨骨折、肺挫伤、感染、肺部症状和 CT 上位于外周的 PE 更多。
这是首次在接受全面双功能超声监测的人群中报告无栓子起源的 DNPE 临床过程的报告。在我们的研究系列中，DNPE 在创伤后似乎更为常见，与 DVT 后出现的 PE 在临床上不同，并且可能代表对损伤或炎症的局部反应；然而，需要进一步的研究来充分了解 DNPE 的病理生理学。
护理管理研究，III 级。
