继续医学教育
急性肺栓塞常用危险分层评估研究进展
陶禹至
韩婧
刘维佳
张湘燕
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DOI: 10.3760/cma.j.cn112147-20211009-00699
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摘要

急性肺栓塞(APE)发病率逐年上升,但缺乏临床特异性症状及体征。一旦确诊APE,对患者进行早期危险分层并采取对应的治疗措施,可显著改善患者临床预后。本文就目前常用的几种APE危险分层评估工具进行综述,为临床诊疗与后续研究提供一定理论依据和思路。

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陶禹至,韩婧,刘维佳,等. 急性肺栓塞常用危险分层评估研究进展[J]. 中华结核和呼吸杂志,2022,45(03):325-328.

DOI:10.3760/cma.j.cn112147-20211009-00699

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急性肺栓塞(acute pulmonary embolism,APE)发病率呈上升趋势 1,但其临床表现缺乏特异性,临床医师很难仅根据症状或体征评估APE严重程度,而早期危险分层是APE临床处理的关键步骤,关系到下一步临床决策。APE危险分层评分作为一种决策工具,通过临床、实验室或影像学等参数综合预测以确定出现既定终点事件的可能性以指导治疗 2。我国肺栓塞注册登记研究(CURES) 1结果显示,使用优化基于危险分层的APE诊治策略可显著降低住院患者病死率,其与临床的相关性已得到有效证实。本文就近年临床应用较广泛的APE危险分层评估工具综述如下。
附录
问答题(单选题)

1.目前急性肺栓塞常用危险分层评估工具不包括以下哪一项()

A.sPESI;

B.BOVA评分;

C.FAST评分;

D.Caprini评分

2.以下哪一项不属于2018版中国APE指南危险分层评估量表用以分层评估的项目()

A.血压;

B.右心室功能障碍;

C.心率;

D.心肌实验室标志物

3.2019年ESC指南满足以下何种条件即可评估为高危()

A.血流动力学不稳定;

B.PESI分层Ⅲ~Ⅴ级;

C.右心室功能障碍;

D.肌钙蛋白升高

4.2019年ESC指南APE严重程度评估量表不包括()

A.肌钙蛋白;

B.血流动力学;

C.右心室功能障碍;

D.氧合指数

5.2018版中国APE指南危险分层评估量表用于区分中高危的指标为下列哪一项()

A.休克;

B.右心室功能障碍及心肌实验室标志物升高;

C.晕厥;

D.低氧血症

参考文献
[1]
Zhang J , Zhou H , Aili A ,et al. Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study[J]. J Thorac Dis, 2021,13(2):541-551. DOI: 10.21037/jtd-20-2552 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
李敏,许伟,陈艳,. 晕厥联合cTNT、PESI评分在209例急性肺栓塞患者中的临床分析[J]. 临床肺科杂志, 2020,25(12):1800-1804. DOI: 10.3969/j.issn.1009-6663.2020.12.005 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Konstantinides SV , Meyer G , Becattini C ,et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)[J]. Eur Heart J, 2020,41(4):543-603. DOI: 10.1093/eurheartj/ehz405 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Moor J , Baumgartner C , Méan M ,et al. Validation of the 2019 European society of cardiology risk stratification algorithm for pulmonary embolism in normotensive elderly patients[J]. Thromb Haemost, 2021,121(12):1660-1667. DOI: 10.1055/a-1475-2263 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Konstantinides SV , Meyer G , Becattini C ,et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)[J]. Eur Heart J, 2020,41(4):543-603. DOI: 10.1093/eurheartj/ehz405 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Ayöz S , Erol S , Kul M ,et al. Using RV/LV ratio and cardiac biomarkers to define the risk of mortality from pulmonary embolism[J]. Tuberk Toraks, 2021,69(3):297-306. DOI: 10.5578/tt.20219701 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018,98(14):1060-1087. DOI: 10.3760/cma.j.issn.0376-2491.2018.14.007 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Burgos LM , Scatularo CE , Cigalini IM ,et al. The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score[J]. Eur Heart J Acute Cardiovasc Care, 2021,10(3):250-257. DOI: 10.1093/ehjacc/zuaa007 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Jen WY , Jeon YS , Kojodjojo P ,et al. A new model for risk stratification of patients with acute pulmonary embolism[J]. Clin Appl Thromb Hemost, 2018,24(9_suppl):277S-284S. DOI: 10.1177/1076029618808922 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Soriano LA , Castro TT , Vilalva K ,et al. Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil[J]. J Bras Pneumol, 2019,45(1):e20170251. DOI: 10.1590/1806-3713/e20170251 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Yamashita Y , Morimoto T , Amano H ,et al. Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry[J]. Eur Heart J Acute Cardiovasc Care, 2020,9(4):262-270. DOI: 10.1177/2048872618799993 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Moumneh T , Wells PS , Miranda S . Risk stratification of pulmonary embolism[J]. Crit Care Clin, 2020,36(3):437-448. DOI: 10.1016/j.ccc.2020.02.002 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
王晓芳,张运剑,刘春萍. 三种评分体系对急性肺血栓栓塞症预后评估的比较[J]. 中华急诊医学杂志, 2018,27(10):1158-1163. DOI: 10.3760/cma.j.issn.1671-0282.2018.10.019 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Jara-Palomares L , Alfonso M , Maestre A ,et al. Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged < 50 years [J]. Sci Rep, 2019,9(1):20064. DOI: 10.1038/s41598-019-55213-8 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Vinson DR , Ballard DW , Mark DG ,et al. Risk stratifying emergency department patients with acute pulmonary embolism: does the simplified pulmonary embolism severity index perform as well as the original? [J]. Thromb Res, 2016,148:1-8. DOI: 10.1016/j.thromres.2016.09.023 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Pelland-Marcotte MC , Tucker C , Klaassen A ,et al. Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study[J]. Lancet Haematol, 2019,6(3):e144-e153. DOI: 10.1016/S2352-3026(18)30224-2 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Hepburn-Brown M , Irving L , Hammerschlag G . Early decision-making in acute pulmonary embolism: a retrospective clinical audit[J]. Intern Med J, 2019,49(4):481-489. DOI: 10.1111/imj.14042 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Chen X , Shao X , Zhang Y ,et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: a systematic review and meta-analysis[J]. Thromb Res, 2020,193:99-106. DOI: 10.1016/j.thromres.2020.05.047 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Bova C , Vanni S , Prandoni P ,et al. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism[J]. Thromb Res, 2018,165:107-111. DOI: 10.1016/j.thromres.2018.04.002 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
陈璐,侯银静,秦明照. 肺血栓栓塞症危险分层及预后评分在高龄非高危肺栓塞患者中的应用[J]. 中国心血管杂志, 2019,24(5):434-438. DOI: 10.3969/j.issn.1007-5410.2019.05.010 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Hobohm L , Hellenkamp K , Hasenfuß G ,et al. Comparison of risk assessment strategies for not-high-risk pulmonary embolism[J]. Eur Respir J, 2016,47(4):1170-1178. DOI: 10.1183/13993003.01605-2015 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Hobohm L , Becattini C , Konstantinides SV ,et al. Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism[J]. Clin Res Cardiol, 2020,109(8):1008-1017. DOI: 10.1007/s00392-019-01593-w .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Hobohm L , Hellenkamp K , Hasenfuß G ,et al. Comparison of risk assessment strategies for not-high-risk pulmonary embolism[J]. Eur Respir J, 2016,47(4):1170-1178. DOI: 10.1183/13993003.01605-2015 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Hobohm L , Becattini C , Konstantinides SV ,et al. Validation of a fast prognostic score for risk stratification of normotensive patients with acute pul monary embolism [J]. Clin Res Cardiol, 2020,109(8):1008-1017. DOI: 10.1007/s00392-019-01593-w .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Solverson K , Humphreys C , Liang Z ,et al. Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score[J]. ERJ Open Res, 2021,7(2). DOI: 10.1183/23120541.00879-2020 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Zhang J , Zhou H , Aili A ,et al. Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study[J]. J Thorac Dis, 2021,13(2):541-551. DOI: 10.21037/jtd-20-2552 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Vedovati MC , Cimini LA , Pierpaoli L ,et al. Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study[J]. Eur Heart J Acute Cardiovasc Care, 2020,9(4):286-292. DOI: 10.1177/2048872620913849 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Kozlowska M , Plywaczewska M , Koc M ,et al. D-dimer assessment improves the simplified pulmonary embolism severity index for in-hospital risk stratification in acute pulmonary embolism[J]. Clin Appl Thromb Hemost, 2018,24(8):1340-1346. DOI: 10.1177/1076029618776799 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Chopard R , Jimenez D , Serzian G ,et al. Renal dysfunction improves risk stratification and may call for a change in the management of intermediate-and high-risk acute pulmonary embolism: results from a multicenter cohort study with external validation[J]. Crit Care, 2021,25(1):57. DOI: 10.1186/s13054-021-03458-z .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Kostrubiec M , Pływaczewska M , Jiménez D ,et al. The prognostic value of renal function in acute pulmonary embolism-a multi-centre cohort study[J]. Thromb Haemost, 2019,119(1):140-148. DOI: 10.1055/s-0038-1676522 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Becattini C , Vedovati MC , Pruszczyk P ,et al. Oxygen saturation or respiratory rate to improve risk stratification in hemodynamically stable patients with acute pulmonary embolism[J]. J Thromb Haemost, 2018,16(12):2397-2402. DOI: 10.1111/jth.14299 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Montes Santiago J , Argibay Filgueira AB . Home treatment of venous thromboembolism disease[J]. Rev Clin Esp, 2020. DOI: 10.1016/j.rce.2020.03.008 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
张湘燕,Email: mocdef.6ab2126753yxz
B

陶禹至, 韩婧, 刘维佳, 等. 急性肺栓塞常用危险分层评估研究进展[J]. 中华结核和呼吸杂志, 2022, 45(3): 325-328. DOI: 10.3760/cma.j.cn112147-20211009-00699.

C
所有作者声明无利益冲突
D
中国医学科学院中央级公益性科研院所基本科研专项资金 (2019PT320003)
2021年贵州省卫生健康委科学技术基金项目 (gzwkj2021-089)
2021年贵州省卫生健康委科学技术基金项目 (gzwkj2021-091)
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