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 5 页)
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41. Thrombophilia evaluation in pulmonary embolism.
41. 肺栓塞的血栓形成倾向评估PMID:日期:2019-08-08[中文摘要] 肺栓塞患者常因多种原因接受血栓形成倾向评估，包括复发性静脉血栓栓塞症（VTE）的风险分层及治疗方案的制定。然而，在许多临床情境下，血栓形成倾向检测的实用性仍不明确。本综述评估了VTE共识指南中关于血栓形成倾向检测的当前推荐意见、近期关于这些推荐意见临床应用的相关文献、针对遗传性血栓形成倾向的新型基因评估方法，以及评估直接口服抗凝药（DOACs）在合并血栓形成倾向的VTE患者中应用的研究。当前VTE指南建议有限度地使用血栓形成倾向检测，认识到检测结果可能被误读，且往往不会导致治疗方案的改变。检测及检测结果并非必然无害，常被误读，并可能导致患者和临床医生焦虑增加。近期研究提供了创新技术，以更好地使临床实践与这些推荐意见保持一致，同时扩展了基因组评估，以提高血栓形成倾向检测的范围和预测价值。此外，关于直接口服抗凝药治疗在合并遗传性血栓形成倾向或抗磷脂综合征的VTE患者中适用性的文献也在不断涌现。当前形式的血栓形成倾向检测对大多数VTE患者的临床管理没有显著影响，也未改善其结局。因此，应审慎使用，仅适用于检测结果可能改变临床管理的患者。新型扩展的基因组血栓形成倾向检测方法，以及评估各种血栓形成倾向亚群中最佳抗凝治疗的进一步研究，将使血栓形成倾向检测在未来对患者更有价值。
[英文摘要] Patients with pulmonary embolism commonly undergo thrombophilia evaluation for a variety of reasons including risk stratification for recurrent venous thromboembolism (VTE) and treatment planning. However, the utility of thrombophilia testing in many clinical scenarios remains unclear. This review evaluates current recommendations for thrombophilia testing described in consensus VTE guidelines, recent literature on the clinical application of these recommendations, novel genetic assessments for hereditary thrombophilias, and studies evaluating use of direct oral anticoagulants (DOACs) in VTE patients with thrombophilias. Current VTE guidelines advise limited use of thrombophilia testing, recognizing that testing may be misinterpreted and frequently does not lead to a change in management. Testing and test results are not necessarily benign, are frequently misinterpreted, and can lead to increased anxiety in both patients and clinicians. Recent studies have offered innovative techniques to better align clinical practice with these recommendations as well as expanded genomic assessments to improve the scope and predictive value of thrombophilia testing. There is also emerging literature on the appropriateness of direct oral anticoagulant therapy for VTE patients with hereditary thrombophilias or antiphospholipid syndrome. Thrombophilia testing in its current form does not significantly impact clinical management or improve outcomes for most VTE patients. Therefore, it should be employed judiciously and only in patients for whom it is likely to alter clinical management. Novel expanded genomic thrombophilia testing approaches and additional studies evaluating optimal anticoagulant treatment in various thrombophilia subpopulations will make thrombophilia testing more useful for patients moving forward.
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42. Post-Pulmonary Embolism Syndrome: An Update Based on the Revised AWMF-S2k Guideline.
42. 肺栓塞后综合征：基于修订版AWMF-S2k指南的更新PMID:日期:2024-03-26[中文摘要] 在急性肺栓塞（PE）存活者中，可能出现肺栓塞后综合征（PPES）。在PPES中，患者通常表现为尽管接受了3个月的治疗性抗凝，仍存在持续性或进行性劳力性呼吸困难。因此，有必要进行结构化随访，以识别肺动脉压正常的慢性血栓栓塞性肺疾病（CTEPD）或慢性血栓栓塞性肺动脉高压（CTEPH）患者。两者目前均被理解为一种双重血管病变，即继发性动脉病和小动脉病，累及大、中型肺动脉以及外周血管（直径<50µm）。急性PE后的随访流程首先从识别临床症状和CTEPH危险因素开始。如有指征，应逐步进行超声心动图、通气-灌注扫描（或替代影像学检查）、N末端脑钠肽前体（NT-proBNP）水平检测、心肺运动试验以及肺动脉导管检查伴血管造影。CTEPH患者应在具备丰富复杂治疗选择经验的多学科中心接受治疗，治疗手段包括肺动脉内膜剥脱术、球囊肺动脉成形术和药物干预。
[英文摘要] In survivors of acute pulmonary embolism (PE), the post-PE syndrome (PPES) may occur. In PPES, patients typically present with persisting or progressive dyspnea on exertion despite 3 months of therapeutic anticoagulation. Therefore, a structured follow-up is warranted to identify patients with chronic thromboembolic pulmonary disease (CTEPD) with normal pulmonary pressure or chronic thromboembolic pulmonary hypertension (CTEPH). Both are currently understood as a dual vasculopathy, that is, secondary arterio- and arteriolopathy, affecting the large and medium-sized pulmonary arteries as well as the peripheral vessels (diameter < 50 µm). The follow-up algorithm after acute PE commences with identification of clinical symptoms and risk factors for CTEPH. If indicated, a stepwise performance of echocardiography, ventilation-perfusion scan (or alternative imaging), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level, cardiopulmonary exercise testing, and pulmonary artery catheterization with angiography should follow. CTEPH patients should be treated in a multidisciplinary center with adequate experience in the complex therapeutic options, comprising pulmonary endarterectomy, balloon pulmonary angioplasty, and pharmacological interventions.
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43. Pulmonary Embolism in 2017: How We Got Here and Where Are We Going?
43. 2017年的肺栓塞：我们是如何走到这一步的，我们要去哪里？PMID:日期:2017-07-05[中文摘要] 20世纪70年代，尿激酶肺栓塞试验和尿激酶-链激酶肺栓塞试验开启了开发溶栓疗法治疗急性大面积和次大面积肺栓塞（PE）的探索。这些研究的目标是即刻减少血栓负荷、恢复血流动力学稳定以及提高生存率。大出血成为临床医生采用这些疗法的主要障碍。从20世纪80年代至今，多项使用重组组织型纤溶酶原激活剂以实现上述相同结局的研究已完成，但大出血始终是 adoption barrier。最后，将溶栓药物导入血栓内部这一理念已成为肺栓塞治疗中追寻的“圣杯”。本文将回顾所有使用外周溶栓的主要试验，并深入探讨肺栓塞护理团队协作模式（肺栓塞快速反应团队）的必要性、肺栓塞分类标准化的需求，以及针对特定肺栓塞人群开展溶栓治疗短期和长期结局评估试验的必要性。
[英文摘要] In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier. Finally, the concept of bringing the thrombolytic agent into the clot has entered the quest for the Holy Grail in the treatment of PE. This article will review all the major trials using peripheral thrombolysis and provide insight into the need for a team approach to pulmonary care (Pulmonary Embolism Response Team), standardization of pulmonary classification, and the need for trials designed for both short- and long-term outcomes using thrombolysis for selected PE populations.
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44. Pulmonary embolism response teams.
44. 肺栓塞反应小组PMID:日期:2017-04-13[中文摘要] 肺栓塞（PE）是一种常见的血栓性事件，其临床表现多样。根据患者的死亡风险，指南提供了多种治疗策略，包括溶栓、导管导向治疗、肺动脉取栓术、抗凝以及下腔静脉滤器。然而，各指南之间在患者的最佳治疗策略方面存在相当大的分歧，尤其是对于中危肺栓塞患者。为了提供快速且个体化的诊疗，肺栓塞快速反应团队（PERT）应运而生。这些团队由来自不同专科、对肺栓塞有特别兴趣、具备不同技术技能和临床经验的成员组成，从而实现多学科协作。PERT有助于达成共识决策，并对病情恶化的患者迅速实施干预。在本综述中，我们概述了肺栓塞的治疗指南，以及近期涉及次大面积肺栓塞患者的临床试验结果。此外，我们还讨论了我们的诊疗思路概要及PERT的应用。
[英文摘要] Pulmonary embolism (PE) is a common thrombotic event that is variable in its presentation. Depending on the patients' risk for mortality, guidelines provide several treatment strategies including thrombolysis, catheter-directed therapies, pulmonary embolectomy, anticoagulation, and inferior vena cava filters. However, there is considerable disagreement between guidelines regarding the optimal treatment strategy for patients, particularly for those with intermediate-risk PE. In order to provide rapid and individualized care, PE response teams (PERT) have been developed. These teams consist of members from different specialties with a particular interest in PE, varying technical skills, and clinical experience, thereby allowing for a multidisciplinary approach. PERT allows for consensus decision making, and for rapid intervention in patients whose conditions worsen. In this review, we provide an overview of treatment guidelines for PE, and of results from recent clinical trials involving patients with submassive PE. In addition, we discuss an outline of our approach and use of PERT.
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45. Management of incidental pulmonary embolism.
45. 偶发性肺栓塞的管理PMID:日期:2017-06-29[中文摘要] 偶发性肺栓塞(PE)是胸部常规计算机断层扫描(CT)中常见的发现,在冠状动脉CT扫描中发生率为1.1%，在肿瘤学CT扫描中为3.6%。尽管发生率如此之高，偶发性PE的最佳管理尚未在临床试验中得到研究，仍是争论的主题。虽然这些CT扫描并非采用专门的PE方案进行，且对比剂增强效果欠佳，但偶发性PE的诊断已被证明在段级和亚段级动脉水平上是准确的。偶发性PE的栓塞负荷低于症状性PE。即便如此，观察性研究表明，就复发性静脉血栓性疾病风险和死亡率而言，偶发性PE的自然病程与症状性PE相似。有趣的是，更先进CT技术的使用增加与偶发性亚段PE发生率的上升相吻合，症状性亚段PE亦是如此。尽管缺乏临床试验，且观察性数据仅限于癌症相关的偶发性PE，但共识认为偶发性PE的管理与症状性PE相同，包括最佳药物类别的选择、门诊治疗及总疗程。
[英文摘要] Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of oncological CT scans. Despite this high frequency, optimal management of incidental PE has not been addressed in clinical trials and remains the subject of debate. Although these CT scans have not been performed with a dedicated PE protocol and have suboptimal contrast enhancement, diagnosis of incidental PE has been shown to be accurate up to the segmental and subsegmental arteries. The embolic load in incidental PE is lower than that in symptomatic PE. Even so, observational studies suggest that the natural course of incidental PE is similar to that of symptomatic PE with regard to the risk of recurrent venous thrombotic disease and mortality. Interestingly, the increased use of more advanced CT technology has coincided with an increase in the rate of incidental subsegmental PE, as is the case for symptomatic subsegmental PE. Although clinical trials are lacking, and observational data are limited to cancer-associated incidental PE, the consensus is that the management of incidental PE is identical to that of symptomatic PE, including the choice of optimal drug class, outpatient treatment and total duration of treatment.
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46. Clinical significance and management of subsegmental pulmonary embolism.
46. 亚段性肺栓塞的临床意义与管理PMID:日期:2015-03-17[中文摘要] 计算机断层扫描肺血管造影（CTPA）对诊断亚段肺动脉充盈缺损具有较高的敏感性。将CTPA作为肺栓塞（PE）诊断的首选诊断方式，导致肺栓塞的诊断率上升。然而，尽管肺栓塞诊断率上升，其病死率却较低，且肺栓塞的死亡率保持不变，提示该疾病的严重程度较轻。对于诊断为孤立性亚段肺栓塞（SSPE）的患者，在排除深静脉血栓（DVT）的情况下，是否需要抗凝治疗还是可以保守管理，临床上仍存在均衡的不确定性。欧洲心脏病学会（ESC）近期的建议提出，对于新诊断的SSPE患者，应根据抗凝治疗的风险/获益比以及是否存在下肢DVT，采取个体化的管理策略。需要评估SSPE管理策略安全性和有效性的前瞻性数据，以确定这些患者的最佳管理方案。
[英文摘要] Computed tomographic pulmonary angiography (CTPA) has a high sensitivity for diagnosing filling defects in subsegmental pulmonary arteries. The adoption of CTPA as the preferred diagnostic modality for the diagnosis of pulmonary embolism (PE) has led to an increased rate of PE diagnosis. However, the case fatality rate is lower and the mortality rate of PE has remained unchanged despite this rise in PE diagnosis suggesting that the disease is of lesser severity. There continues to be clinical equipoise on whether patients diagnosed with isolated subsegmental PE (SSPE) require anticoagulation or can be managed conservatively if the presence of deep vein thrombosis (DVT) has been excluded. Recent recommendations from the European Society of Cardiology suggest an individualized approach for the management of patients with newly diagnosed SSPE based on the risk/benefit ratio of anticoagulation and the presence of lower limb DVT. Prospective data evaluating the safety and efficacy of management strategies for SSPE is needed in order to determine the optimal management of these patients.
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47. Risk stratification and risk-adapted management of acute pulmonary embolism.
47. 急性肺栓塞的风险分层和风险适应性管理PMID:日期:2022-11-07[中文摘要] 肺栓塞是欧洲心血管死亡的主要原因之一。快速诊断和及时启动治疗至关重要，尤其是在血流动力学不稳定的患者中。对于血压正常的患者，诊断流程基于肺栓塞的临床概率。由于鉴别诊断众多且临床表现高度多变，急性肺栓塞的诊断仍然是一项临床挑战。计算机断层扫描血管造影是确诊肺栓塞的常用金标准，而床旁超声心动图在临床决策中具有重要影响。欧洲心脏病学会指南为标准化诊断方法和风险预测提供了框架。基于生命体征、临床评分、生物标志物和影像学结果，可定义四种风险类别并据此进行治疗。为优化危重患者的个体化管理，越来越多的专业中心设立了多学科肺栓塞快速反应团队。本文概述了急性肺栓塞患者当前的风险适应性管理策略。
[英文摘要] Pulmonary embolism is one of the leading causes of cardiovascular death in Europe. Rapid diagnosis and treatment initiation are essential, especially in hemodynamically unstable patients. For normotensive patients, the diagnostic workflow is based on the clinical probability of pulmonary embolism. Due to numerous differential diagnoses and a highly variable clinical presentation, diagnosis of acute pulmonary embolism still remains a clinical challenge. Computed tomography angiography is the common gold standard to confirm pulmonary embolism and bedside echocardiography adds a major impact in clinical decision making. The European Society of Cardiology guidelines serve as a framework for a standardized diagnostic approach and risk prediction. Based on vital signs, clinical scores, biomarkers and imaging results, four risk categories can be defined and treatment is accordingly. To optimize the individual management of critical patients, multidisciplinary pulmonary embolism response teams are increasingly designated in specialized centers. This article provides an overview of the current risk-adapted management of patients with acute pulmonary embolism.
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48. Venous Thromboembolism in COVID-19.
48. 新冠肺炎静脉血栓栓塞PMID:日期:2020-10-24[中文摘要] 2019冠状病毒病（COVID-19）是我们最近一次大流行，此前2009年的H1N1猪流感持续了约19个月。COVID-19的一个特殊特征是其引起静脉血栓栓塞症（VTE）的倾向。血栓炎症似乎在发病机制中发挥重要作用。本文将对发病机制中的一些机制进行综述，并讨论一些血液学生物标志物，以及它们是否可作为VTE的有用危险因素。我们评估了针对内科疾病患者的一般风险评估模型在COVID-19中的具体作用。基于现有证据，我们综述了预防措施的类型，特别是应使用标准剂量还是增强剂量的药物预防。我们还比较了10个不同指南或立场/共识声明的建议。以当前一般治疗指南为参考，讨论了COVID-19合并肺栓塞患者的治疗建议。指出了COVID-19患者的特殊性，并探讨了溶栓治疗的潜在作用。
[英文摘要] The coronavirus disease 2019 (COVID-19) is our latest pandemic, preceded by the H1N1 swine flu in 2009, which lasted approximately 19 months. One of the special characteristics of COVID-19 is the propensity to cause venous thromboembolism (VTE). Thromboinflammation seems to play a prominent role in the pathogenesis. We will here review some mechanisms in the pathogenesis and discuss some hematological biomarkers, and also whether they serve as useful risk factors for VTE. The role of general risk assessment models for medically ill patients specifically in COVID-19 is appraised. The type of prophylaxis and particularly whether standard or augmented doses of chemoprophylaxis should be used is reviewed based on available evidence. We are also comparing recommendations from 10 different guidance or position/consensus statements. Treatment recommendations for patients with COVID-19 and pulmonary embolism are discussed with current general treatment guidelines as reference. Specifics for patients with COVID-19 are pointed out and the potential role of thrombolytic treatment is explored.
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49. Heart Failure and Embolism.
49. 心力衰竭和栓塞PMID:日期:2026-07-30[中文摘要] 心力衰竭与栓塞常并存，并具有共同的病理生理机制，包括血流淤滞、内皮功能障碍和炎症。两者的临床表现常具有误导性，使诊断具有挑战性，因此需要恰当运用不同的影像学技术。本文总结了这两种疾病的病理生理联系、诊断难点及管理策略，并概述了基于证据和指南指导的预防与治疗策略，包括炎症的作用、心房心肌病以及更新的抗凝建议。
[英文摘要] Heart failure and embolism frequently coexist and share common pathophysiologic mechanisms, including stasis, endothelial dysfunction and inflammation. Their clinical presentations can often be misleading, which makes the diagnostic challenging and mandates appropriate use of different imaging techniques. This article summarizes the pathophysiological links, diagnostic challenges and management strategies of these 2 entities. It also outlines evidence-based and guideline-directed strategies for prevention and treatment, including the role of inflammation, atrial cardiomyopathy and updated anticoagulation recommendations.
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50. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
50. 2026年AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN成人急性肺栓塞评估和管理指南：美国心脏病学会/美国心脏协会临床实践指南联合委员会的报告PMID:日期:2026-02-19[中文摘要] “2026年成人急性肺栓塞评估和管理AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN指南”是一项全新的指南，为急性肺栓塞（急性PE）成年患者（≥18岁）的评估、管理和随访提供了全面的建议。本指南的一个关键特征是引入了AHA/ACC急性肺栓塞临床分类，提高了严重程度分类、预后评估和循证治疗决策的准确性。2024年2月至2024年10月进行了全面的文献检索，以确定在MEDLINE（通过PubMed）、EMBASE、Cochrane图书馆、医疗保健研究和质量局以及与本指南相关的其他选定数据库中以英文发表的针对人类受试者的临床研究、综述和其他证据。指南编写委员会酌情增加了截至2025年4月发表的部分关键研究。本临床实践指南的重点是采用循证和以患者为中心的方法对成年患者进行急性肺栓塞评估和管理。本指南涵盖了从症状发作到临床随访的时期，重点是风险结果评估、急性肺栓塞的临床诊断、辅助心血管检测的适当使用以及肺栓塞急性期和急性后早期阶段的管理。它解决了急性肺栓塞和相关结果的循证诊断和管理策略（包括药物治疗、高级介入治疗和住院支持）。
[英文摘要] The "2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults" is a de novo guideline that provides comprehensive recommendations for the evaluation, management, and follow-up of adult patients (≥18 years of age) with acute pulmonary embolism (acute PE). A key feature of this guideline is the introduction of the AHA/ACC Acute Pulmonary Embolism Clinical Categories, which enhance the precision of severity classification, prognosis assessment, and evidence-based therapeutic decision-making. A comprehensive literature search was conducted from February 2024 to October 2024 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Select key studies published until April 2025 were added by the guideline writing committee as appropriate. The focus of this clinical practice guideline is an evidence-based and patient-centered approach for acute PE evaluation and management of the adult patient. This guideline encompasses the period from the onset of symptoms through clinical follow-up, focusing on risk outcomes assessment, clinical diagnosis of acute PE, appropriate use of adjunctive cardiovascular testing, and management in both the acute and early post-acute phases of PE. It addresses evidence-based diagnostic and management strategies (including pharmacological therapies, advanced interventional therapies, and in-hospital support) for acute PE and associated outcomes.