Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
Chest. 2021 Jan;159(1):347-355. doi: 10.1016/j.chest.2020.07.065. Epub 2020 Aug 3.
Pulmonary embolism (PE) is a major source of morbidity and mortality. The presentation of acute PE varies, ranging from few or no symptoms to sudden death. Patient outcome depends on how well the right ventricle can sustain the increased afterload caused by the embolic burden. Careful risk stratification is critical, and the PE response team (PERT) concept offers a rapid and multidisciplinary approach. Anticoagulation is essential unless contraindicated; thrombolysis, surgical embolectomy, and catheter-directed approaches are also available. Clinical consensus statements have been published that offer a guide to PE management, but areas remain for which the evidence is inadequate. Although the management of low-risk and high-risk patients is more straightforward, optimal management of intermediate-risk patients remains controversial. In this document, we offer a case-based approach to PE management, beginning with diagnosis and risk stratification, followed by therapeutic alternatives, and finishing with follow-up care.
肺栓塞（PE）是发病率和死亡率的主要原因。急性 PE 的表现差异很大，从几乎没有症状到突然死亡。患者的预后取决于右心室对栓塞负荷引起的后负荷增加的代偿能力。仔细的风险分层至关重要，PE 反应团队（PERT）的概念提供了一种快速和多学科的方法。除非有禁忌证，否则抗凝是必不可少的；溶栓、外科取栓和导管引导的方法也可使用。已经发表了临床共识声明，为 PE 的管理提供了指导，但仍有一些领域证据不足。虽然低危和高危患者的管理更为简单，但中危患者的最佳管理仍存在争议。在本文件中，我们提供了一种基于病例的 PE 管理方法，从诊断和风险分层开始，然后是治疗选择，最后是随访护理。
