性肺栓塞诊断和治疗指南2025. 中华心血管病杂志 pulmonary embolism diagnosis therapeutics guideline - PubMed 文献(第 4 页)
PubMed 共收录约 554 篇相关文献，本站只列出其中相关度最高的前 50 篇（共 5 页）；要看全部结果、按影响因子 / 分区 / 年份筛选，请前往完整搜索。
本页是「性肺栓塞诊断和治疗指南2025. 中华心血管病杂志（pulmonary embolism diagnosis therapeutics guideline）」PubMed 检索结果的第 4 页，列出第 31–40 篇相关文献；主题介绍见第 1 页。
性肺栓塞诊断和治疗指南2025. 中华心血管病杂志 的 PubMed 搜索结果(第 4 页)
-
31. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
31. 肝素诱导的血小板减少症的治疗和预防：抗血栓治疗和血栓预防，第9版：美国胸科医师学会循证临床实践指南PMID:日期:2012-02[中文摘要] 肝素诱导的血小板减少症（HIT）是一种抗体介导的药物不良反应，可导致严重的血栓栓塞并发症，包括肺栓塞、需截肢的缺血性肢体坏死、急性心肌梗死和卒中。本指南的方法学遵循本增刊中《抗血栓治疗与血栓预防指南制定方法学：抗血栓治疗与血栓预防，第9版：美国胸科医师学会循证临床实践指南》。本文的关键推荐意见如下：对于接受肝素治疗且临床医生认为HIT风险>1%的患者，我们建议从第4天至第14天每2或3天监测一次血小板计数（或直至停用肝素，以先发生者为准）（2C级）。对于接受肝素治疗且临床医生认为HIT风险<1%的患者，我们建议不监测血小板计数（2C级）。对于伴有血栓形成的HIT（HITT）或单纯性HIT且肾功能正常的患者，我们建议使用阿加曲班、来匹卢定或达那肝素，而非其他非肝素类抗凝药（2C级）。对于HITT合并肾功能不全的患者，我们建议使用阿加曲班，而非其他非肝素类抗凝药（2C级）。对于需要紧急心脏手术的急性HIT或亚急性HIT患者，我们建议使用比伐卢定，而非其他非肝素类抗凝药或肝素联合抗血小板药物（2C级）。仍需进一步研究评估磺达肝癸钠和新型口服抗凝药在HIT治疗中的作用。
[英文摘要] Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke. The methods of this guideline follow the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Among the key recommendations for this article are the following: For patients receiving heparin in whom clinicians consider the risk of HIT to be > 1%, we suggest that platelet count monitoring be performed every 2 or 3 days from day 4 to day 14 (or until heparin is stopped, whichever occurs first) (Grade 2C). For patients receiving heparin in whom clinicians consider the risk of HIT to be < 1%, we suggest that platelet counts not be monitored (Grade 2C). In patients with HIT with thrombosis (HITT) or isolated HIT who have normal renal function, we suggest the use of argatroban or lepirudin or danaparoid over other nonheparin anticoagulants (Grade 2C). In patients with HITT and renal insufficiency, we suggest the use of argatroban over other nonheparin anticoagulants (Grade 2C). In patients with acute HIT or subacute HIT who require urgent cardiac surgery, we suggest the use of bivalirudin over other nonheparin anticoagulants or heparin plus antiplatelet agents (Grade 2C). Further studies evaluating the role of fondaparinux and the new oral anticoagulants in the treatment of HIT are needed.
-
32. [European guidelines on the diagnosis and management of pulmonary embolism].
32. [欧洲肺栓塞诊断和管理指南]PMID:期刊:Lijecnicki vjesnik PubMed[中文摘要] 我们报告欧洲心脏病学会《急性肺栓塞诊断与管理指南》2008年更新版，该指南已获得克罗地亚心脏病学会的认可和推荐。该指南重点关注目前可用且经过验证的诊断方法、预后评估（结局与死亡风险预测）、肺栓塞的治疗以及特定情况下的管理，包括妊娠、恶性肿瘤、非血栓性肺栓塞、右心血栓、肝素诱导的血小板减少症、慢性血栓栓塞性肺动脉高压。这些指南的新颖之处在于将肺栓塞分为肺栓塞相关早期死亡高风险、低风险和中等风险，而非使用诸如“大面积”、“次大面积”和“非大面积”肺栓塞等具有误导性的术语，这对治疗具有重要影响。抗凝治疗仍是主要治疗手段，对于表现为心源性休克和/或持续性动脉低血压的高风险肺栓塞患者，溶栓治疗是一种治疗选择。
[英文摘要] We report on the 2008 update of Guidelines on the diagnosis and management of acute pulmonary embolism (PE) of the European Society of Cardiology that have been endorsed and recommended by the Croatian Cardiac Society. The guidelines focus on currently available and validated methods of diagnosis, prognostic assessment (prediction of outcome and death risk), treatment of pulmonary embolism and management in specific settings including pregnancy, malignancy, non-thrombotic PE, right heart thrombi, heparin-induced thrombocytopenia, chronic thromboembolic pulmonary hypertension. The novelty of these guidelines is the stratification of PE into high-risk, low-risk and intermediate-risk of PE-related early death, which has important consequences for treatment, rather than the use of misleading terms such as zmassive', zsubmassive' and znon-massive' pulmonary embolism. The anticoagulants remain the mainstay of therapy, with thrombolytic therapy being an therapeutic option in patients with high-risk PE presenting with cardiogenic shock and/or persistent arterial hypotension.
-
33. Pulmonary embolism critical care update: prognosis, treatment, and research gaps.
33. 肺栓塞重症监护最新进展：预后、治疗及研究空白PMID:日期:2018-10-17[中文摘要] 我们及时更新了临床医生和急性肺栓塞患者所面临的治疗护理问题，这些患者伴有右心室劳损（次大面积肺栓塞）或休克（大面积肺栓塞）。过去几年的护理和研究变化导致了四个重要趋势：在急性护理临床医生和研究人员中，对急性肺栓塞严重程度的描述和沟通方式更加一致和准确；风险预测评分系统的可用性和使用增加；在严重右心室功能障碍的情况下，先进侵入性治疗的使用增加；以及多学科肺栓塞反应团队的出现，以指导标准护理决策。伴有休克的肺栓塞在没有禁忌症的情况下，应使用全身性或导管为基础的溶栓治疗。伴有右心功能障碍的次大面积肺栓塞患者接受溶栓治疗，可能会经历右心室功能的更快改善，并且不太可能进展为血流动力学失代偿。然而，这会带来大出血风险增加。我们的建议是，在次大面积肺栓塞病例中考虑导管为基础或全身性纤溶治疗，这些患者表现出高风险特征，如：超声或CT显示严重右心室劳损，更重要的是尽管抗凝治疗，脉搏、收缩压和氧合随时间恶化趋势。理解先进治疗超越标准抗凝对以患者为中心的结果（如功能状态和生活质量）的影响，代表了一个研究知识空白。
[英文摘要] We provide a timely update on treatment care issues facing clinicians and patients with acute pulmonary embolism accompanied by either right ventricular strain (sub-massive pulmonary embolism) or shock (massive pulmonary embolism). Care and research changes over the last several years have resulted in four important trends: more consensus and accuracy in the way acute pulmonary embolism severity is described and communicated among acute care clinicians and researchers, increased availability and use of risk prediction scoring systems, increased use of advanced invasive therapy in the setting of severe right ventricular dysfunction, and emergence of multidisciplinary pulmonary embolism response teams to guide standard care decision-making. Pulmonary embolism with shock should be treated with either systemic or catheter-based thrombolytic therapy in the absence of contraindications. Patients with sub-massive pulmonary embolism accompanied by right heart dysfunction who are treated with thrombolytic therapy likely will experience more rapid improvement in RV function and are less likely to progress to hemodynamic decompensation. This comes, however, with an increased risk of major bleeding. Our recommendation is to consider catheter-based or systemic fibrinolytic therapy in sub-massive pulmonary embolism cases where patients demonstrate high-risk features such as: severe RV strain on echo or CT, and importantly worsening over time trends in pulse, SBP, and oxygenation despite anticoagulation. Understanding the impact of advanced therapy beyond standard anticoagulation on patient-centered outcomes, such as functional status and quality of life represent a research knowledge gap.
-
34. Pulmonary Embolism: An Update Based on the Revised AWMF-S2k Guideline.
34. 肺栓塞：基于修订的AWMF-S2k指南的更新PMID:日期:2024-04-30[中文摘要] 肺栓塞（PE）是第三大常见急性心血管疾病。肺栓塞的风险随年龄增长而增加，且死亡率较高。患者被分为血流动力学稳定和不稳定两类，因为这对诊断和治疗具有重要意义。由于急性肺栓塞的临床体征和症状缺乏特异性，因此通过评估肺栓塞的临床可能性来指导诊断路径。对于血流动力学稳定、肺栓塞可能性低或中等的患者，进行D-二聚体检测，而血栓栓塞及其后遗症的显像通常通过计算机断层扫描肺动脉造影（CTPA）实现，并辅以超声技术。在确诊肺栓塞后，另一项风险分层用于评估疾病严重程度，并确定后续治疗强度和场所。治疗范围从门诊初始口服抗凝治疗，到在重症监护室或导管室进行溶栓或介入治疗。在个别病例中，甚至尝试急性外科血栓切除术。
[英文摘要] 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.
-
35. Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism.
35. 急性肺栓塞后慢性血栓栓塞性肺动脉高压的诊断PMID:日期:2020-06-25[中文摘要] 慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞（PE）最严重的长期并发症。未经治疗的CTEPH是致命的，但如果能及时诊断，成功的手术（肺动脉内膜剥脱术）、药物（肺动脉高压药物）和/或介入（球囊肺动脉成形术）治疗已被证明可改善临床结局，尤其是在肺动脉内膜剥脱术成功的情况下。然而，早期诊断已被证明具有挑战性。患者和医生对该疾病的认识不足、肺栓塞后综合征（急性肺栓塞诊断后持续存在的呼吸困难、功能受限和/或生活质量下降）的高患病率、缺乏明确的指南推荐以及临床实践中诊断性检查的低效应用，导致据报道诊断延迟时间长达1年以上。因此，亟需改进当前临床实践并更早地诊断CTEPH。在本综述中，我们将聚焦于CTEPH的临床表现和危险因素，并基于一个临床病例，提供来自专家中心的肺栓塞随访项目的最佳实践方案。
[英文摘要] Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). Untreated CTEPH is fatal, but, if diagnosed in time, successful surgical (pulmonary endarterectomy), medical (pulmonary hypertension drugs) and/or interventional (balloon pulmonary angioplasty) therapies have been shown to improve clinical outcomes, especially in case of successful pulmonary endarterectomy. Early diagnosis has however been demonstrated to be challenging. Poor awareness of the disease by patients and physicians, high prevalence of the post-PE syndrome ( persistent dyspnoea, functional limitations and/or decreased quality of life following an acute PE diagnosis), lack of clear guideline recommendations as well as inefficient application of diagnostic tests in clinical practice lead to a reported staggering diagnostic delay >1 year. Hence, there is a great need to improve current clinical practice and diagnose CTEPH earlier. In this review, we will focus on the clinical presentation of and risk factors for CTEPH, and provide best practices for PE follow-up programmes from expert centres, based on a clinical case.
-
36. [Diagnosis and management of acute pulmonary embolism. ESC guidelines 2014].
36. [急性肺栓塞的诊断和管理。2014年ESC指南]PMID:日期:2015-12[中文摘要] 急性肺栓塞（PE）在快速诊断和风险适应性治疗方面仍是一项挑战。在2014年欧洲心脏病学会（ESC）关于急性肺栓塞诊断与管理的指南中，基于新的研究数据发布了多项新推荐。一些已确立的风险分层评分得到进一步完善，目前已有充分证据支持使用年龄调整的D-二聚体截断值。对于无休克临床特征患者的风险分层，推荐使用肺栓塞严重程度指数（PESI）及简化肺栓塞严重程度指数（sPESI）评分。对于中危患者，可通过计算机断层扫描或超声心动图评估右心室形态和功能，生物标志物有助于进一步风险分层。对于伴或不伴肺栓塞的静脉血栓栓塞症患者的治疗，非维生素K依赖性口服抗凝药（NOACs）是肝素联合维生素K拮抗剂标准抗凝方案的安全替代选择。全身性溶栓治疗应限于高危或中高危伴血流动力学不稳定的患者。最后，针对慢性血栓栓塞性肺动脉高压（CTEPH）患者、合并癌症患者及妊娠期患者的诊断与治疗，也给出了新的推荐。
[英文摘要] Acute pulmonary embolism (PE) still represents a challenge regarding a rapid diagnosis and a risk-adapted therapy. In the 2014 guidelines of the European Society of Cardiology (ESC) on the diagnosis and management of acute PE, several new recommendations have been issued based on new study data. Some established scores for risk stratification were developed further and there is now good evidence for the use of age-adjusted D-dimer cut-off levels. For the risk stratification in patients without clinical features of shock, the utilization of the pulmonary embolism severity index (PESI) and simplified PESI (sPESI) scores is recommended. In patients with intermediate risk, right ventricular morphology and function can be evaluated by computer tomography or echocardiography and biomarkers facilitate further risk stratification. For the treatment of patients with venous thromboembolism with or without PE, the non-vitamin K-dependent oral anticoagulants (NOACs) are a safe alternative to the standard anticoagulation regimen with heparin and vitamin K antagonists. Systemic thrombolytic therapy should be restricted to patients with high risk or intermediate high risk with hemodynamic instability. Finally, new recommendations for the diagnosis and therapy of patients with chronic thromboembolic pulmonary hypertension (CTEPH), with cancer or during pregnancy are given.
-
37. [Pulmonary embolism].
37. [肺栓塞]PMID:日期:2017-02-17[中文摘要] 肺栓塞是一种潜在致死性疾病，常见于重症监护和急诊医学领域。由于其在最初数小时内死亡率较高，对疑似肺栓塞患者准确启动合理的诊断路径并及时进行后续治疗至关重要。本综述介绍了当前欧洲关于急性肺栓塞诊断与治疗的指南，特别关注基于个体早期死亡风险的结构化患者管理。本文尤其对风险评估及新的风险调整治疗建议进行了介绍和讨论。
[英文摘要] Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. In this review, the current European guidelines on the diagnosis and therapy of acute pulmonary embolism are presented. Special focus is put on a structured patient management based on the individual risk of early mortality. In particular risk assessment and new risk-adjusted treatment recommendations are presented and discussed in this article.
-
38. Chronic thromboembolic pulmonary hypertension.
38. 慢性血栓栓塞性肺动脉高压PMID:日期:2019-01-24[中文摘要] 慢性血栓栓塞性肺动脉高压(CTEPH)是肺栓塞的并发症,也是导致慢性肺动脉高压、进而引起右心衰竭和死亡的主要原因。肺通气/灌注显像是首选的筛查检查;显像正常可排除CTEPH。若灌注显像异常,则需进行高质量的肺动脉造影以确认和明确肺血管受累情况,并在作出治疗决策前完成。肺动脉高压通过右心导管检查确诊,该检查也是确定治疗方案所必需的。除长期抗凝治疗外,每位CTEPH患者均应接受治疗评估,首先评估是否适合行肺动脉内膜剥脱术,这是指南推荐的治疗方法。对于技术上无法手术的病例,推荐采用针对肺动脉高压的靶向药物治疗(目前基于CHEST研究为利奥西呱),并应在具备该技术经验的中心考虑行球囊肺动脉成形术,该介入具有挑战性,但可能有效且为补充性治疗手段。
[英文摘要] Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic PH leading to right heart failure and death. Lung ventilation/perfusion scintigraphy is the screening test of choice; a normal scan rules out CTEPH. In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. PH is confirmed with right heart catheterisation, which is also necessary for treatment determination. In addition to chronic anticoagulation therapy, each patient with CTEPH should receive treatment assessment starting with evaluation for pulmonary endarterectomy, which is the guideline recommended treatment. For technically inoperable cases, PH-targeted medical therapy is recommended (currently riociguat based on the CHEST studies), and balloon pulmonary angioplasty should be considered at a centre experienced with this challenging but potentially effective and complementary intervention.
-
39. Evaluation and Management of Intermediate and High-Risk Pulmonary Embolism.
39. 中危和高危肺栓塞的评估与管理PMID:日期:2019-11-19[中文摘要] 过去10年间，关于肺栓塞治疗的证据取得了显著进展，尤其是在合并右心室功能障碍或血流动力学不稳定的患者中。治疗选择包括全身抗凝、全身溶栓、导管辅助血栓清除（机械取栓联合或不联合导管定向溶栓）以及外科取栓术。本文将综述现有治疗选择的数据，并总结关于中危或高危肺栓塞治疗的循证指南。
[英文摘要] The evidence regarding pulmonary embolism treatment has greatly advanced over the past 10 years, particularly in patients with right ventricular dysfunction or hemodynamic instability. Treatment options include systemic anticoagulation, systemic thrombolysis, catheter-assisted thrombus removal (mechanical with or without catheter-directed thrombolysis), and surgical embolectomy. This article will review the data available for treatment options and summarize the evidence-based guidelines on treatment of intermediate- or high-risk pulmonary embolism.
-
40. Acute pulmonary embolism: risk assessment, risk stratification and treatment options.
40. 急性肺栓塞：风险评估、风险分层和治疗方案PMID:日期:2015-04-23[中文摘要] 肺栓塞（PE）是一种潜在危及生命的心血管急症，死亡率高。快速诊断和治疗对于优化PE患者的临床结局至关重要，抗凝治疗是其主要治疗手段。传统抗凝治疗包括肠外抗凝药物，与口服维生素K拮抗剂重叠使用并随后续贯使用。直接口服抗凝药（DOACs），包括Xa因子抑制剂利伐沙班、阿哌沙班和依度沙班，以及直接凝血酶抑制剂达比加群酯，已被研发用于解决传统抗凝治疗相关的局限性。阿哌沙班、达比加群和利伐沙班近期已获批用于治疗急性深静脉血栓形成（DVT）和PE以及预防DVT或PE复发。依度沙班已在美国获批，但目前尚未在欧盟获批用于治疗DVT和PE；预计依度沙班不久将在欧洲获得批准。本文旨在根据近期指南总结疑似PE患者的管理，并讨论近期DOACs获批用于治疗PE背后的证据。PE的诊断和治疗以临床概率评分系统以及预后分层和早期死亡风险评估工具为指导。抗凝药物仍是主要治疗手段。成功的III期试验已证实DOACs治疗DVT和PE的疗效，且安全性特征可能更优，促使其近期获得该适应症的批准，并为临床医生在此情况下提供了更多抗凝治疗选择。与传统抗凝药物相比，DOACs为PE患者的抗凝治疗提供了一种替代且可能更为简化的选择，有望帮助医生优化PE患者的管理并改善临床结局。
[英文摘要] Pulmonary embolism (PE) is a potentially life-threatening cardiovascular emergency with a high mortality rate. Rapid diagnosis and treatment are important in optimising clinical outcomes in patients with PE, and anticoagulants are the mainstay of treatment. Traditionally, anticoagulant therapy involves parenteral anticoagulants, overlapping with and followed by oral vitamin K antagonists. Direct oral anticoagulants (DOACs), including the factor Xa inhibitors rivaroxaban, apixaban and edoxaban, and the direct thrombin inhibitor dabigatran etexilate, have been developed to address limitations associated with traditional anticoagulant therapy. Apixaban, dabigatran and rivaroxaban have recently been approved for the treatment of acute deep vein thrombosis (DVT) and PE and prevention of recurrent DVT or PE. Edoxaban is approved in the United States but not currently in the European Union for the treatment of DVT and PE; approval of edoxaban in Europe is anticipated in the near future. To summarise the management of patients with suspected PE in accordance with recent guidelines, and to discuss the evidence behind the recent approvals of the DOACs for the treatment of PE. Diagnosis and treatment of PE is guided by clinical probability scoring systems and tools for prognostic stratification and early mortality risk evaluation. Anticoagulants remain the mainstay of treatment. Successful phase III trials have demonstrated the efficacy of the DOACs for the treatment of DVT and PE, with a potentially improved safety profile, leading to their recent approval in this indication, and giving the clinician greater choice of anticoagulant therapies in this setting. DOACs offer an alternative and potentially simplified option for anticoagulation therapy in patients with PE compared with traditional anticoagulants and are likely to assist physicians in optimising management of patients with PE and improve clinical outcomes.