Hull R D, Hirsh J, Carter C J, Jay R M, Dodd P E, Ockelford P A, Coates G, Gill G J, Turpie A G, Doyle D J, Buller H R, Raskob G E
Ann Intern Med. 1983 Jun;98(6):891-9. doi: 10.7326/0003-4819-98-6-891.
Inherent contradictions in current diagnostic recommendations for pulmonary embolism have created considerable confusion and controversy. To resolve these contradictions, we did a prospective study of ventilation-perfusion scanning, pulmonary angiography, and venography in consecutive patients with clinically suspected pulmonary embolism and abnormal perfusion scans. Ventilation scanning increased the probability of pulmonary embolism in patients with large perfusion defects and ventilation mismatch, but a ventilation-perfusion match was not helpful in ruling out pulmonary embolism. Small perfusion defects with mismatch had neither sufficiently high nor low probability to be of diagnostic value. The observed frequency of proximal vein thrombosis (19% to 51%) and its association with the range of ventilation-perfusion defects have important implications for management of pulmonary embolism. Pulmonary angiography is required in combination with venography in most patients with perfusion abnormalities because the probability of pulmonary embolism is neither sufficiently high nor low to confirm or exclude pulmonary embolism.
目前肺栓塞诊断建议中存在的内在矛盾引发了相当大的困惑和争议。为解决这些矛盾，我们对连续的临床疑似肺栓塞且灌注扫描异常的患者进行了通气-灌注扫描、肺动脉造影和静脉造影的前瞻性研究。通气扫描增加了存在大的灌注缺损和通气不匹配患者发生肺栓塞的可能性，但通气-灌注匹配对排除肺栓塞并无帮助。存在不匹配的小灌注缺损其发生肺栓塞的可能性既不够高也不够低，因此没有诊断价值。观察到的近端静脉血栓形成频率（19%至51%）及其与通气-灌注缺损范围的关联对肺栓塞的管理具有重要意义。大多数有灌注异常的患者需要将肺动脉造影与静脉造影结合使用，因为发生肺栓塞的可能性既不够高也不够低，无法确诊或排除肺栓塞。
