Reamy Brian V, Williams Pamela M, Odom Michael Ryan
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Am Fam Physician. 2017 Sep 1;96(5):306-312.
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made. Validated clinical decision rules are available to help exclude coronary artery disease. Viruses are common causative agents of pleuritic chest pain. Coxsackieviruses, respiratory syncytial virus, influenza, parainfluenza, mumps, adenovirus, cytomegalovirus, and Epstein-Barr virus are likely pathogens. Treatment is guided by the underlying diagnosis. Nonsteroidal anti-inflammatory drugs are appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain. In patients with persistent symptoms, persons who smoke, and those older than 50 years with pneumonia, it is important to document radiographic resolution with repeat chest radiography six weeks after initial treatment.
胸膜炎性胸痛的特点是在吸气和呼气时胸部突然出现强烈的刺痛、刀割样或烧灼样疼痛。肺栓塞是最常见的严重病因，在因胸膜炎性胸痛就诊于急诊科的患者中，其发生率为5%至21%。应采用经过验证的肺栓塞临床决策规则来指导使用其他检查，如D - 二聚体检测、通气 - 灌注扫描或计算机断层血管造影。心肌梗死、心包炎、主动脉夹层、肺炎和气胸是其他应在做出其他诊断之前，通过病史、体格检查、心电图、肌钙蛋白检测和胸部X线检查排除的严重病因。有经过验证的临床决策规则可用于帮助排除冠状动脉疾病。病毒是胸膜炎性胸痛的常见病原体。柯萨奇病毒、呼吸道合胞病毒、流感病毒、副流感病毒、腮腺炎病毒、腺病毒、巨细胞病毒和EB病毒是可能的病原体。治疗以潜在诊断为指导。非甾体类抗炎药适用于病毒引发或非特异性胸膜炎性胸痛患者的疼痛管理。对于持续有症状的患者、吸烟者以及50岁以上患有肺炎的患者，在初始治疗六周后通过重复胸部X线检查记录影像学上的病灶消退情况很重要。
