Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Semin Respir Crit Care Med. 2021 Apr;42(2):299-307. doi: 10.1055/s-0041-1722964. Epub 2021 Feb 6.
Acute pulmonary embolism (PE) is not only a serious and potentially life-threatening disease in the acute phase, in recent years it has become evident that it may also have a major impact on a patient's daily life in the long run. Persistent dyspnea and impaired functional status are common, occurring in up to 50% of PE survivors, and have been termed the post-PE syndrome (PPES). Chronic thromboembolic pulmonary hypertension is the most feared cause of post-PE dyspnea. When pulmonary hypertension is ruled out, cardiopulmonary exercise testing can play a central role in investigating the potential causes of persistent symptoms, including chronic thromboembolic pulmonary disease or other cardiopulmonary conditions. Alternatively, it is important to realize that post-PE cardiac impairment or post-PE functional limitations, including deconditioning, are present in a large proportion of patients. Health-related quality of life is strongly influenced by PPES, which emphasizes the importance of persistent limitations after an episode of acute PE. In this review, physiological determinants and the diagnostic management of persistent dyspnea after acute PE are elucidated.
急性肺栓塞（PE）不仅在急性期是一种严重且潜在威胁生命的疾病，近年来，它还可能对患者的长期日常生活产生重大影响。持续性呼吸困难和功能状态受损很常见，在多达 50%的 PE 幸存者中发生，被称为 PE 后综合征（PPES）。慢性血栓栓塞性肺动脉高压是 PE 后呼吸困难最可怕的原因。当排除肺动脉高压后，心肺运动试验可在调查持续性症状的潜在原因方面发挥核心作用，包括慢性血栓栓塞性肺疾病或其他心肺疾病。或者，重要的是要认识到，PE 后心脏损伤或 PE 后功能限制，包括身体适应不良，在很大一部分患者中存在。PPES 强烈影响健康相关生活质量，强调了急性 PE 发作后持续存在的限制。在这篇综述中，阐明了急性 PE 后持续性呼吸困难的生理决定因素和诊断管理。
