Boon Gudula J A M, Bogaard Harm Jan, Klok Frederikus A
Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands.
Department of Pulmonary Diseases Institute for Cardiovascular Research (ICaR-VU) Amsterdam University Medical Center location VUmc Amsterdam The Netherlands.
Res Pract Thromb Haemost. 2020 Aug 2;4(6):958-968. doi: 10.1002/rth2.12404. eCollection 2020 Aug.
Care for patients with acute pulmonary embolism (PE) involves more than determination of the duration of anticoagulant therapy. After choosing the optimal initial management strategy based on modern risk stratification schemes, patients require focused attention aimed at prevention of major bleeding, identification of underlying (malignant) disease, prevention of cardiovascular disease, and monitoring for long-term complications. The most frequent complication of PE is the so-called "post-PE syndrome," a phenomenon of permanent functional limitations after PE occurring in up to 50% of patients. The post-PE syndrome is caused by persistent deconditioning, anxiety, and/or ventilatory or circulatory impairment as a result of acute PE. The most severe and most feared presentation of the post-PE syndrome is chronic thromboembolic pulmonary hypertension (CTEPH), a deadly disease if it remains untreated. While CTEPH may be successfully treated with pulmonary endarterectomy, balloon pulmonary angioplasty, and/or pulmonary hypertension drugs, the major challenge is to diagnose CTEPH at an early stage. Poor awareness for the post-PE syndrome and in particular for CTEPH, high prevalence of persistent symptoms after PE and inefficient application of diagnostic tests in clinical practice all contribute to an unacceptable diagnostic delay and underdiagnosis. Its consequences are dire: increased mortality in patients with CTEPH, and excess health care costs, higher prevalence of depression, more unemployment and poorer quality of life in patients with post-PE syndrome in general. In this review, we provide an overview of the incidence and impact of the post-PE syndrome, and illustrate the clinical presentation, optimal diagnostic strategy as well as therapeutic options.
对急性肺栓塞（PE）患者的护理不仅仅是确定抗凝治疗的持续时间。在根据现代风险分层方案选择最佳初始管理策略后，患者需要重点关注预防大出血、识别潜在（恶性）疾病、预防心血管疾病以及监测长期并发症。PE最常见的并发症是所谓的“PE后综合征”，在高达50%的患者中，PE后会出现永久性功能受限的现象。PE后综合征是由急性PE导致的持续身体机能下降、焦虑和/或通气或循环功能障碍引起的。PE后综合征最严重且最令人恐惧的表现是慢性血栓栓塞性肺动脉高压（CTEPH），如果不治疗，这是一种致命疾病。虽然CTEPH可以通过肺动脉内膜切除术、球囊肺动脉血管成形术和/或肺动脉高压药物成功治疗，但主要挑战是早期诊断CTEPH。对PE后综合征尤其是CTEPH的认识不足、PE后持续症状的高发生率以及临床实践中诊断测试应用效率低下，都导致了不可接受的诊断延迟和漏诊。其后果是严重的：CTEPH患者死亡率增加，医疗费用过高，PE后综合征患者中抑郁症患病率更高、失业率更高且总体生活质量更差。在本综述中，我们概述了PE后综合征的发生率和影响，并阐述了其临床表现、最佳诊断策略以及治疗选择。
