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[妊娠相关肺栓塞的预防、诊断与管理]

[The prevention, diagnosis and management of pregnancy-associated pulmonary embolism].

作者信息

Tang P P, Gao J S

机构信息

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Aug 6;104(30):2785-2790. doi: 10.3760/cma.j.cn112137-20240229-00446.

Abstract

Pregnancy-associated pulmonary embolism (PE) is a type of venous thromboembolism (VTE) that seriously threatens the lives of pregnant women and has gained more attention in clinical practice. Due to physiological and anatomical characteristics, the incidence of VTE during pregnancy and postpartum is significantly higher than that during non-pregnancy periods. Currently, guidelines widely acknowledge the exploration of appropriate risk assessment models to evaluate the risk of pregnancy-associated VTE and to take corresponding preventive measures from mechanical to medication methods according to different risk levels. For patients suspected of PE, initial assessments can be made based on whether they exhibit clinical manifestations of deep vein thrombosis, with options including vascular compression ultrasonography or chest X-ray examination. Confirmation relies on CT pulmonary angiography or V/Q imaging. For patients with shock, echocardiography can be quickly used for the diagnosis and differential diagnosis of PE. The management of pregnancy-associated pulmonary embolism PE depends on the patient's hemodynamic status, with options including reperfusion therapy or anticoagulation therapy. Extracorporeal membrane oxygenation may also be beneficial in high risk patients. The overall evidence level for the prevention and management of pregnancy-associated PE is low, and further exploration in clinical practice is still needed to promote the safety of pregnant women.

摘要

妊娠相关肺栓塞(PE)是一种静脉血栓栓塞症(VTE),严重威胁孕妇生命,在临床实践中受到越来越多的关注。由于生理和解剖学特征,孕期及产后VTE的发生率明显高于非孕期。目前,指南广泛认可探索合适的风险评估模型,以评估妊娠相关VTE的风险,并根据不同风险水平采取从机械方法到药物方法的相应预防措施。对于疑似PE的患者,可根据其是否表现出深静脉血栓形成的临床表现进行初步评估,选择包括血管压迫超声检查或胸部X线检查。确诊依赖于CT肺动脉造影或V/Q显像。对于休克患者,可快速使用超声心动图进行PE的诊断和鉴别诊断。妊娠相关肺栓塞(PE)的治疗取决于患者的血流动力学状态,选择包括再灌注治疗或抗凝治疗。体外膜肺氧合对高危患者可能也有益处。妊娠相关PE预防和治疗的总体证据水平较低,仍需要在临床实践中进一步探索以提高孕妇的安全性。

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