Stevenson Alexander, Davis Sarah, Murch Nick
Acute Medicine Department, Royal Free Hospital, London, UK.
Br J Hosp Med (Lond). 2020 Jun 2;81(6):1-12. doi: 10.12968/hmed.2020.0300. Epub 2020 Jun 18.
Pulmonary embolism remains an important cause of morbidity and mortality in the UK, particularly following the outbreak of the novel coronavirus 2019 (COVID-19), where those infected have an increased prevalence of venous thromboembolic events. The pathophysiology in COVID-19 patients is thought to relate to a thromboinflammatory state within the pulmonary vasculature, triggered by the infection, but other risk factors such as reduced mobility, prolonged immobilisation and dehydration are likely to contribute. Several societies have released comprehensive guidelines emphasising the importance of risk stratification in patients with acute pulmonary embolism. They advocate the use of clinically validated risk scores in conjunction with biochemical and imaging results. Patients with mild disease can now be managed in the outpatient setting and with newly developed therapies, such as catheter-directed thrombolysis, becoming available in more centres, treatment options for those with more severe disease are also expanding. This article presents four theoretical but realistic cases, each diagnosed with acute pulmonary embolism, but differing in levels of severity. These demonstrate how the guidelines can be applied in a clinical setting, with particular focus on risk stratification and management.
在英国，肺栓塞仍然是发病和死亡的重要原因，尤其是在2019年新型冠状病毒（COVID-19）疫情爆发之后，感染者发生静脉血栓栓塞事件的患病率有所增加。COVID-19患者的病理生理学被认为与肺部血管系统内的血栓炎症状态有关，这种状态由感染引发，但其他风险因素，如活动减少、长期制动和脱水，也可能起作用。多个学会已发布全面指南，强调对急性肺栓塞患者进行风险分层的重要性。他们主张结合生化和影像学结果使用经过临床验证的风险评分。现在，轻症患者可在门诊治疗，随着新开发的疗法（如导管定向溶栓）在更多中心可用，重症患者的治疗选择也在增加。本文介绍了四个理论上但现实可行的病例，每个病例均被诊断为急性肺栓塞，但严重程度不同。这些病例展示了如何在临床环境中应用指南，特别关注风险分层和管理。
