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肺栓塞患者病程中慢性血栓栓塞性肺动脉高压诊断的“指引明灯”

["Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism].

作者信息

Chazova I E, Martynyuk T V, Gorbachevskii S V, Gramovich V V, Danilov N M, Panchenko E P, Chernyavskiy A M, Shmalts A A, Yavelov I S

机构信息

Chazov National Medical Research Center of Cardiology.

The Russian National Research Medical University named after N.I. Pirogov.

出版信息

Ter Arkh. 2022 Oct 24;94(9):1052-1056. doi: 10.26442/00403660.2022.09.201836.

Abstract

On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.

摘要

2021年12月13日,召开了一次专家委员会会议,以确定不同专业的专家对于在新型冠状病毒感染大流行的实际临床实践中慢性血栓栓塞性肺动脉高压(CTEPH)诊断水平较低的原因,以及提高对有肺栓塞(PE)病史患者检测率的可能方法。CTEPH诊断水平较低的原因包括专家,尤其是基层医疗医生的知识水平不足;缺乏针对这类患者管理的明确规范性文件和专家中心。在大流行期间,可以通过广泛使用远程医疗,让基层医疗医生与专家中心的专家进行会诊,来加强CTEPH的初步诊断;最大限度地发挥超声心动图和计算机断层扫描(CT)作为呼吸困难鉴别诊断工具的作用,特别是在新冠肺炎患者中。为了提高CTEPH的检测率,对于有风险因素和静脉血栓栓塞发作的患者需要保持诊断警惕性。为了改进CTEPH的筛查,有必要创建一个对有PE病史患者进行监测的算法;开展教育活动,包括通过媒体进行;为患者创建提供易懂信息的资料。规范性文件应指定负责对PE患者进行长期监测的专家范围。需要为基层医疗医生、心脏病专家以及其他进入CTEPH患者视野的医生开展教育项目;引入一个创建专家中心的项目,以便对患者进行监测和管理,能够进行通气灌注肺闪烁扫描、心肺应激试验、CT、右心导管检查。与俄罗斯卫生部建立合作,以制定管理PE和CTEPH患者的特殊方案和程序似乎很重要。

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