Pulmonary Embolism: An Update Based on the Revised AWMF-S2k Guideline

Christian F. Opitz, F. Joachim Meyer
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Abstract

Pulmonary embolism (PE) is the third most common acute cardiovascular disease. The risk of PE increases with age and mortality is high. Patients are stratified into hemodynamically stable versus unstable patients, as this has important implications for diagnosis and therapy. Since clinical signs and symptoms of acute PE are nonspecific, the clinical likelihood of PE is estimated to guide diagnostic pathways. D-dimer testing is performed in hemodynamically stable patients with low or intermediate probability of PE and the visualization of thromboembolism and its sequelae is commonly achieved with computed tomography pulmonary angiography (CTPA), supplemented by ultrasound techniques. With confirmed PE, another risk stratification estimates disease severity and defines intensity and setting of the ensuing treatment. The therapeutic spectrum ranges from outpatient treatment with initial oral anticoagulation to thrombolytic or interventional treatment in the intensive care unit or catheterization laboratory. In single cases, even acute surgical thrombectomy is attempted.

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肺栓塞:基于 AWMF-S2k 指南修订版的更新
肺栓塞(PE)是第三大最常见的急性心血管疾病。肺栓塞的风险随着年龄的增长而增加,死亡率也很高。患者被分为血流动力学稳定型和不稳定型,因为这对诊断和治疗有重要影响。由于急性 PE 的临床症状和体征无特异性,因此要估计 PE 的临床可能性,以指导诊断路径。对于血流动力学稳定、发生 PE 可能性较低或中等的患者,应进行 D-二聚体检测,血栓栓塞及其后遗症的显像通常通过计算机断层扫描肺血管造影术(CTPA)实现,并辅以超声波技术。对于确诊的 PE,另一种风险分层方法可估计疾病的严重程度,并确定随后治疗的强度和方法。治疗范围从最初口服抗凝剂的门诊治疗到重症监护室或导管室的溶栓或介入治疗。在个别病例中,甚至会尝试急性外科血栓切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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