使用结合临床概率,D-二次测试和计算机断层扫描的算法来管理疑似肺栓塞的有效性
Arne van Belle1, Harry R Büller, Menno V Huisman
1Department of Pulmonary Medicine, Academic Hospital, Maastricht, The Netherlands.
JAMA
|January 13, 2006
概括
使用临床决策规则和D-二次体测试的简化算法有效地诊断肺栓塞 (PE). 这种方法安全地减少了对计算机断层扫描 (CT) 扫描的需求,并降低了静脉血栓栓塞 (VTE) 的风险.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 以前的研究已经探索了肺栓塞 (PE) 的复杂诊断策略.
- 评估更简单,更有效的诊断途径对于患者管理至关重要.
研究的目的:
- 评估疑似肺栓塞 (PE) 的简化诊断算法的临床有效性.
- 该算法集成了二分体化的临床决策规则,D-二分体测试和计算机断层扫描 (CT).
主要方法:
- 一项前性队列研究,涉及3306名疑似急性肺栓塞 (PE) 的患者,遍及荷兰12个中心.
- 患者使用二分化的威尔斯规则进行分类:"PE不太可能"或"PE可能".
- 不太可能的病例接受了D-二聚体测试;正常结果排除了PE. 其他患者进行CT扫描以确定确诊. 随访时间为3个月,以监测有症状或致命的静脉血栓栓塞 (VTE).
主要成果:
- 肺栓塞 (PE) 在66.7%的患者中不太可能发生. 在这个群体中,一个正常的D-二次测试 (占总体的32.0%) 没有导致抗凝血作用,非致命的VTE发生率为0.5%.
- 计算机断层扫描 (CT) 在20.4%的患者中证实了PE. 在阴性CT (45.3%的总数) 和没有抗凝药的患者中,3个月VTE发病率为1.3%.
- 该算法在97.9%的病例中促进了管理决策,导致致命或非致命的VTE的总体风险较低.
结论:
- 结合简化临床决策规则,D-二次体检测和CT的诊断策略对于管理疑似肺栓塞 (PE) 是有效的.
- 这种方法与随后致命和非致命静脉血栓栓塞 (VTE) 的低风险有关.
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