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美国肺栓塞反应团队的发展:文献综述

Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature.

作者信息

Pandya Vidish, Chandra Akhil Avunoori, Scotti Andrea, Assafin Manaf, Schenone Aldo L, Latib Azeem, Slipczuk Leandro, Khaliq Asma

机构信息

Division of Cardiology, Montefiore Health System, Albert Einstein College of Medicine, 111 E 210TH ST, Bronx, NY 10467, USA.

出版信息

J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984.

Abstract

Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, with varying presentations and management challenges. Traditional treatment approaches often differ, particularly for submassive/intermediate-risk PEs, because of the lack of clear guidelines and comparative data on treatment efficacy. The introduction of pulmonary embolism response teams (PERTs) aims to standardize and improve outcomes in acute PE management through multidisciplinary collaboration. This review examines the conception, evolution, and operational mechanisms of PERTs while providing a critical analysis of their implementation and efficacy using retrospective trials and recent randomized trials. The study also explores the integration of advanced therapeutic devices and treatment protocols facilitated by PERTs. PERT programs have significantly influenced the management of both massive and submassive PEs, with notable improvements in clinical outcomes such as decreased mortality and reduced length of hospital stay. The utilization of advanced therapies, including catheter-directed thrombolysis and mechanical thrombectomy, has increased under PERT guidance. Evidence from various studies, including those from the National PERT Consortium, underscores the benefits of these multidisciplinary teams in managing complex PE cases, despite some studies showing no significant difference in mortality. PERT programs have demonstrated potentials to reduce morbidity and mortality, streamlining the use of healthcare resources and fostering a model of sustainable practice across medical centers. PERT program implementation appears to have improved PE treatment protocols and innovated advanced therapy options, which will be further refined as they are employed in clinical practice. The continued expansion of the capabilities of PERTs and the forthcoming results from ongoing randomized trials are expected to further define and optimize management protocols for acute PEs.

摘要

肺栓塞(PE)是心血管疾病死亡的一个重要原因,其临床表现多样,管理面临挑战。传统的治疗方法往往存在差异,尤其是对于次大面积/中度风险的肺栓塞,因为缺乏关于治疗效果的明确指南和比较数据。肺栓塞反应团队(PERT)的引入旨在通过多学科协作来规范和改善急性肺栓塞的管理结果。本综述考察了PERT的概念、演变和运作机制,同时利用回顾性试验和近期的随机试验对其实施情况和效果进行批判性分析。该研究还探讨了由PERT推动的先进治疗设备和治疗方案的整合。PERT项目对大面积和次大面积肺栓塞的管理产生了重大影响,在临床结果方面有显著改善,如死亡率降低和住院时间缩短。在PERT的指导下,包括导管定向溶栓和机械血栓切除术在内的先进疗法的使用有所增加。包括国家PERT联盟的研究在内的各种研究证据强调了这些多学科团队在管理复杂肺栓塞病例中的益处,尽管一些研究表明在死亡率方面没有显著差异。PERT项目已显示出降低发病率和死亡率的潜力,简化了医疗资源的使用,并在各医疗中心培育了一种可持续实践的模式。PERT项目的实施似乎改善了肺栓塞治疗方案,并创新了先进的治疗选择,随着它们在临床实践中的应用,这些将得到进一步完善。PERT能力的持续扩展以及正在进行的随机试验即将得出的结果,有望进一步明确和优化急性肺栓塞的管理方案。

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Long-term mortality in patients with pulmonary embolism: results in a single-center registry.肺栓塞患者的长期死亡率:单中心登记研究结果
Res Pract Thromb Haemost. 2023 Jun 14;7(5):100280. doi: 10.1016/j.rpth.2023.100280. eCollection 2023 Jul.

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