Morgan Clinton T, Saha Sibu P
Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
Int J Angiol. 2024 Apr 5;33(2):71-75. doi: 10.1055/s-0044-1782603. eCollection 2024 Jun.
Pulmonary embolism is a major cause of mortality worldwide. In this historical perspective, we aim to provide an overview of the rich medical history surrounding pulmonary embolism. We highlight Virchow's first steps toward understanding the pathophysiology in the 1800s. We see how those insights inspired early attempts at intervention such as surgical pulmonary embolectomy and caval ligation. Those early interventions were refined and ultimately led to the development of inferior vena cava filters, the earliest clinical applications of anticoagulation, and even apparently disparate medical advances such as the successful development of cardiopulmonary bypass. We also see how the diagnosis of pulmonary embolism has evolved from rudimentary monitoring of vitals and symptoms to the development of evermore sophisticated tests such as contrast tomography angiography and echocardiography. Finally, we discuss current approaches to diagnosis, classification, and myriad treatments including anticoagulation, thrombolysis, catheter-directed interventions, surgical embolectomy, and extracorporeal membrane oxygenation guided by Pulmonary Embolism Response Teams.
肺栓塞是全球范围内主要的致死原因。从历史角度来看，我们旨在概述围绕肺栓塞丰富的医学史。我们着重介绍了19世纪维尔肖在理解其病理生理学方面迈出的第一步。我们可以看到这些见解如何激发了早期的干预尝试，如外科肺栓子切除术和腔静脉结扎术。这些早期干预措施不断完善，最终促成了下腔静脉滤器的发展、抗凝治疗的最早临床应用，甚至还有诸如体外循环成功开发等看似毫不相干的医学进展。我们还能看到肺栓塞的诊断是如何从对生命体征和症状的基本监测发展到诸如造影断层血管造影和超声心动图等越来越复杂的检测手段。最后，我们讨论了当前的诊断方法、分类以及包括抗凝、溶栓、导管定向干预、外科栓子切除术和由肺栓塞反应团队指导的体外膜肺氧合等多种治疗方法。
