Briët E, van Beek E J, Oudkerk M
Afd. Hematologie, Academisch Ziekenhuis, Leiden.
Ned Tijdschr Geneeskd. 1993 Jan 30;137(5):255-9.
Pulmonary embolism is a frequent occurrence and requires adequate diagnosis and treatment to avoid unnecessary mortality and complications. However, until recently, the optimal diagnostic management was not determined. This prompted the organisation of a consensus meeting. The advised diagnostic strategy was derived from available data in the literature, a cost-effectiveness analysis, and the discussions which took place at the meeting. The preferred diagnostic strategy consists of a combination of perfusion-ventilation lung scintigraphy, ultrasonography of the legs, and finally pulmonary angiography. Perfusion scintigraphy is performed first. If a normal perfusion is seen further anticoagulant therapy may be withheld. Ventilation scintigraphy is performed if a segmental or larger perfusion defect is found. If a normal ventilation scan is obtained (mismatch) the diagnosis of pulmonary embolism is sufficiently certain to warrant institution of long-term anticoagulant therapy. In all other lung scan findings (non-conclusive or non-diagnostic) the meeting advised to perform ultrasonography of the legs. If deep venous thrombosis is detected the patient requires long-term anticoagulant therapy. If a normal ultrasound result is found, pulmonary angiography is required as the final test in the diagnostic strategy.
肺栓塞很常见，需要进行充分的诊断和治疗以避免不必要的死亡和并发症。然而，直到最近，最佳的诊断管理方法仍未确定。这促使组织了一次共识会议。建议的诊断策略源自文献中的现有数据、成本效益分析以及会议上进行的讨论。首选的诊断策略包括灌注 - 通气肺闪烁扫描、腿部超声检查，最后是肺血管造影。首先进行灌注闪烁扫描。如果灌注正常，可暂停进一步的抗凝治疗。如果发现节段性或更大的灌注缺损，则进行通气闪烁扫描。如果通气扫描正常（不匹配），肺栓塞的诊断足够确定，足以保证开始长期抗凝治疗。对于所有其他肺部扫描结果（不确定或非诊断性），会议建议进行腿部超声检查。如果检测到深静脉血栓形成，患者需要长期抗凝治疗。如果超声结果正常，则需要进行肺血管造影作为诊断策略的最终检查。
