Respiratory Department and Medicine Department, Ramón y Cajal Hospital and Alcalá de Henares University, IRYCIS, 28034, Madrid, Spain.
Respiratory Department, Hospital Araba, Vitoria, Spain.
Intern Emerg Med. 2016 Feb;11(1):11-8. doi: 10.1007/s11739-015-1388-0. Epub 2016 Jan 14.
Patients with acute symptomatic pulmonary embolism (PE) who present with arterial hypotension or shock have a high risk of death (high-risk PE), and treatment guidelines recommend strong consideration of thrombolysis in this setting. For normotensive patients diagnosed with PE, risk stratification should aim to differentiate the group of patients deemed as having a low risk for early complications (all-cause mortality, recurrent venous thromboembolism, and major bleeding) (low-risk PE) from the group of patients at higher risk for PE-related complications (intermediate-high risk PE), so low-risk patients could undergo consideration of early outpatient treatment of PE and intermediate-high risk patients would undergo close observation and consideration of thrombolysis. Clinicians should also use risk stratification and eligibility criteria to identify a third group of patients that should not undergo escalated or home therapy (intermediate-low risk PE). Such patients should initiate standard therapy of PE while in the hospital. Clinical models [e.g., Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI)] may accurately identify those at low risk of dying shortly after the diagnosis of PE. For identification of intermediate-high risk patients with acute PE, studies have validated predictive models that use a combination of clinical, laboratory and imaging variables.
患有急性有症状肺栓塞（PE）且伴有动脉低血压或休克的患者具有较高的死亡风险（高危 PE），治疗指南建议在这种情况下强烈考虑溶栓治疗。对于诊断为 PE 的血压正常患者，风险分层应旨在区分被认为具有低早期并发症风险（全因死亡率、复发性静脉血栓栓塞和大出血）的患者群体（低危 PE）和具有更高 PE 相关并发症风险的患者群体（中高危 PE），因此低危患者可考虑早期门诊治疗 PE，中高危患者则需密切观察并考虑溶栓治疗。临床医生还应使用风险分层和资格标准来确定不应进行升级或家庭治疗的第三组患者（中低危 PE）。这些患者应在入院期间开始接受 PE 的标准治疗。临床模型（例如，肺栓塞严重程度指数（PESI）、简化 PESI（sPESI））可能在 PE 诊断后不久准确识别出那些短期死亡风险较低的患者。对于急性 PE 中高危患者的识别，研究已经验证了使用临床、实验室和影像学变量组合的预测模型。
