Kearon C, Ginsberg J S, Hirsh J
Hamilton Civic Hospitals Research Centre and McMaster University, Ontario, Canada.
Ann Intern Med. 1998 Dec 15;129(12):1044-9. doi: 10.7326/0003-4819-129-12-199812150-00009.
This paper describes the role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Inability to compress the common femoral or popliteal vein is usually diagnostic of a first episode of deep venous thrombosis in symptomatic patients (positive predictive value of about 97%). Full compressibility of both of these sites excludes proximal deep venous thrombosis in symptomatic patients (negative predictive value of about 98%). In patients with suspected deep venous thrombosis or in those who present with suspected pulmonary embolism but have a nondiagnostic lung scan, the subsequent risk for symptomatic venous thromboembolism is very low (<2% during 6 months of follow-up) provided that ultrasonography of the proximal veins remains normal in the course of 1 week (suspected deep venous thrombosis) or 2 weeks (suspected pulmonary embolism). Anticoagulation and further diagnostic testing can usually be safely withheld in these situations. Venous ultrasonography is much less reliable for the diagnosis of asymptomatic, isolated distal, and recurrent deep venous thrombosis than for the diagnosis of a first episode of proximal deep venous thrombosis in symptomatic patients. Clinical evaluation of the probability of deep venous thrombosis or pulmonary embolism, preferably by using a validated clinical model, complements venous ultrasonographic findings and helps to identify patients who would benefit from additional (often invasive) diagnostic testing. Thus, venous ultrasonography is thought to be a very valuable test for the diagnosis and management of patients with suspected deep venous thrombosis or pulmonary embolism.
本文描述了静脉超声检查在疑似深静脉血栓形成和肺栓塞诊断中的作用。对于有症状的患者，无法压迫股总静脉或腘静脉通常可诊断为首次发作的深静脉血栓形成（阳性预测值约为97%）。这两个部位均可完全被压迫可排除有症状患者的近端深静脉血栓形成（阴性预测值约为98%）。对于疑似深静脉血栓形成的患者或那些表现为疑似肺栓塞但肺部扫描结果未确诊的患者，若近端静脉超声检查在1周（疑似深静脉血栓形成）或2周（疑似肺栓塞）内保持正常，则随后发生有症状静脉血栓栓塞的风险非常低（随访6个月期间<２%）。在这些情况下，通常可安全地暂不进行抗凝治疗和进一步的诊断检查。与诊断有症状患者的首次发作近端深静脉血栓形成相比，静脉超声检查对无症状、孤立性远端和复发性深静脉血栓形成的诊断可靠性要低得多。对深静脉血栓形成或肺栓塞可能性的临床评估，最好使用经过验证的临床模型，可补充静脉超声检查结果，并有助于识别那些将从额外的（通常为侵入性的）诊断检查中获益的患者。因此，静脉超声检查被认为是用于诊断和管理疑似深静脉血栓形成或肺栓塞患者的一项非常有价值的检查。
