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[2019年肺栓塞诊断与管理更新指南中内科医生的新内容有哪些?]

[What is new for internists in the updated guidelines on the diagnosis and management of pulmonary embolism 2019?].

作者信息

Monhart Zdeněk

出版信息

Vnitr Lek. 2020 Summer;66(6):386-390.

Abstract

The new guidelines on the diagnosis and management of pulmonary embolism developed in collaboration with the European Respiratory Society were presented on the congress od European society of cardiology in 2019. Are internists concerned, when these guidelines were presented at the congress of cardiologic society? Management of acute pulmonary embolism is less „cathlab dependent“than management of acute coronary syndromes - and pulmonary embolism patients are often treated by internists. Moreover, differential diagnosis of dyspnoea is a everyday problem solved by internists. What is new in the updated guidelines? Refinements in interpretation of Ddimer testing will help us to avoid unnecessary pulmonary angiograms. Nonvitamin K antagonist oral anticoagulants (NOACs) are now the preferred agents for treating the majority of patients with PE, both in the acute phase and over the long term, including selected patients with malignancy. Further important updates include recurrence scores and guidance on extended anticoagulation after PE. A new comprehensive algorithm is proposed for patient followup after acute PE to prevent, detect and treat late sequelae of venous thromboembolism.

摘要

与欧洲呼吸学会合作制定的关于肺栓塞诊断和管理的新指南于2019年在欧洲心脏病学会大会上发布。当这些指南在心脏病学会大会上发布时,内科医生会关注吗?与急性冠状动脉综合征的管理相比,急性肺栓塞的管理对“心导管室的依赖程度”较低,而且肺栓塞患者通常由内科医生治疗。此外,呼吸困难的鉴别诊断是内科医生每天都要解决的问题。更新后的指南有哪些新内容?D-二聚体检测解读的改进将有助于我们避免不必要的肺血管造影。非维生素K拮抗剂口服抗凝剂(NOACs)现在是治疗大多数肺栓塞患者的首选药物,无论是在急性期还是长期,包括特定的恶性肿瘤患者。进一步的重要更新包括复发评分以及肺栓塞后延长抗凝治疗的指导。针对急性肺栓塞后的患者随访,提出了一种新的综合算法,以预防、检测和治疗静脉血栓栓塞的晚期后遗症。

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