Meissner E, Niedermeyer J, Fabel H
Abt. Pneumologie, Medizinische Hochschule Hannover.
Z Kardiol. 1993;82 Suppl 2:3-12.
In the absence of significant symptoms and signs the diagnosis of pulmonary embolism remains difficult. Sensitivity and specificity of laboratory tests, chest x-ray, ECG, echocardiography and venous studies on their own is low. Ventilation-perfusion scanning establishes or excludes the diagnosis only in those patients with "high-probability" or "normal" scanning results. The diagnosis of pulmonary embolism should be made by combining clinical assessment, several diagnostic techniques, and, finally, pulmonary angiography in doubtful cases. Heparin remains the standard therapy for patients with stable hemodynamics. Thrombolytic therapy is recommended in hemodynamically compromised patients. In short-term dose regimens the thrombolytic agents urokinase and rt-PA seem to be equally effective. So far, however, no study has proven that thrombolytic therapy significantly reduces mortality in pulmonary embolism.
在没有明显症状和体征的情况下，肺栓塞的诊断仍然困难。实验室检查、胸部X线、心电图、超声心动图和静脉检查本身的敏感性和特异性都很低。通气-灌注扫描仅能在扫描结果为“高概率”或“正常”的患者中确立或排除诊断。肺栓塞的诊断应结合临床评估、多种诊断技术，最后在可疑病例中进行肺血管造影。肝素仍然是血流动力学稳定患者的标准治疗方法。对于血流动力学受损的患者，推荐溶栓治疗。在短期剂量方案中，溶栓药物尿激酶和重组组织型纤溶酶原激活剂似乎同样有效。然而，到目前为止，尚无研究证明溶栓治疗能显著降低肺栓塞的死亡率。
