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《急性肺栓塞诊断与治疗中国专家共识（2015）》发布

2016-07-11 中华心血管病杂志 中华心血管病杂志

急性肺栓塞
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目前人们对急性肺栓塞的认识不断提高，但临床实践中仍存在误诊、漏诊或诊断不及时以及治疗不规范的情况。中华医学会心血管病学分会肺血管病学组在2010年专家共识基础上，对新近的临床证据进行了系统研判，参考了国际最新急性肺栓塞诊断和治疗指南，经认真研究讨论，制订了本共识，旨在提供我国急性肺栓塞诊治的依据和原则，帮助临床医师做出医疗决策。定义 肺血栓栓塞症（PTE）：是最常见的急性肺栓塞类型，通常所称的急性

目前人们对急性肺栓塞的认识不断提高，但临床实践中仍存在误诊、漏诊或诊断不及时以及治疗不规范的情况。中华医学会心血管病学分会肺血管病学组在2010年专家共识基础上，对新近的临床证据进行了系统研判，参考了国际最新急性肺栓塞诊断和治疗指南，经认真研究讨论，制订了本共识，旨在提供我国急性肺栓塞诊治的依据和原则，帮助临床医师做出医疗决策。

定义 肺血栓栓塞症（PTE）：是最常见的急性肺栓塞类型，通常所称的急性肺栓塞即PTE。深静脉血栓（DVT）：是引起PTE的主要血栓来源，PTE常为DVT的合并症。静脉血栓栓塞症（VTE）：由于PTE与DVT在发病机制上存在相互关联，是同一疾病病程中两个不同阶段的临床表现，因此统称为VTE。易患因素 VTE的易患因素包括患者自身因素与获得性因素。随着研究的深入，不断发现新的易患因素，VTE与动脉疾病尤其是动脉粥样硬化有着共同的危险因素，如吸烟、肥胖、高脂血症、高血压、糖尿病等。

诊断 急性肺栓塞不仅临床表现缺乏特异性，常规检查如胸片、心电图、血气分析、超声心动图等也缺乏特异性。结合我国实际情况，推荐对怀疑急性肺栓塞的患者采取“三步走”策略，首先进行临床可能性评估，然后进行初始危险分层，最后逐级选择检查手段以明确诊断。

急性期治疗在药物、外科或介入再灌注治疗的同时，通常需使用升压药。去甲肾上腺素通过直接正性变力性作用可改善右心室功能，同时通过刺激外周血管α受体升高体循环血压，也能改善右心室冠状动脉灌注，但限于低血压患者。妊娠急性肺栓塞的治疗无休克或持续性低血压的妊娠患者，推荐进行低分子肝素抗凝治疗，需根据体质量调整剂量，一般无需监测，但对于极端体质量或有肾脏疾病的患者，应监测抗Ⅹa因子活性。

——全文刊登于2016年第3期《中华心血管病杂志》

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    2017-04-03 木头人524

    #诊断与治疗#

    0

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    2016-11-19 12498f1em19(暂无昵称)

    #中国专家共识#

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    2016-10-12 1e0ece0dm09(暂无匿称)

    谢谢分享学习

    0

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    2016-10-11 snowpeakxu

    #专家共识#

    0

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    2016-07-13 ms5236388012055669

    #急性肺栓塞#

    0

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