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鉴定患有急性症状性肺栓塞的低风险患者
David Jiménez1, Behnood Bikdeli2, Carmen Rodríguez3
1Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain; Medicine Department, Universidad de Alcalá, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Archivos de bronconeumologia
|July 16, 2023
概括
识别低风险肺栓塞 (PE) 患者的门诊护理是具有挑战性的. 经过修改的简化肺栓塞严重性指数 (sPESI) 与CT评估的RV/LV比率相结合,有效地识别了短期死亡风险非常低的患者.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 对急性肺栓塞 (PE) 的准确风险分层对于确定适当的患者管理,包括门诊护理至关重要.
- 目前用于识别低风险PE患者的方法缺乏明确的清晰度,导致潜在的治疗不足或过度治疗.
研究的目的:
- 识别30天所有原因和PE相关死亡率低风险的急性症状PE患者.
- 评估不同风险评估策略的错误负率在血液动力稳定的PE患者中.
主要方法:
- 利用来自RIETE注册表的血液动力稳定患者队列.
- 我们比较了四种风险分层策略:简化的肺栓塞严重性指数 (sPESI),修改的sPESI (心率截止100次/分钟),以及与CT评估的右心室/左心室 (RV/LV) 比率的组合.
主要成果:
- 整体30天死亡率为4.4% (1.3%与PE相关,3.1%是其他原因).
- 修改后的sPESI和CT评估的RV/LV比率的组合确定了最低比例的低风险患者 (16.5%),但其中30天死亡率最低 (0.4%).
- 与PE相关的死亡率在通过组合修改的sPESI和CT评估的RV/LV比率策略确定为低风险的患者中最低 (0.2%).
结论:
- 阴性修饰的sPESI和CT评估的RV/LV比率≤1的组合确定了急性PE患者的短期死亡风险非常低.
- 这种综合策略可能会提高选择急性PE患者门诊管理的安全性.
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