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肺栓塞诊断的当代方法:临床综述
Dorian Teissandier1, Mélanie Roussel2, Héloise Bannelier1,3
1Department of Emergency, Pitié-Salpêtrière University Hospital, Paris, France.
在急诊室诊断肺栓塞 (PE) 需要采取战略方法. 使用临床概率评估和验证的决策规则,如PERC,YEARS或PEGeD,可以优化诊断并限制不必要的成像.
科学领域:
- 紧急医疗 紧急医疗
- 诊断成像 诊断成像 诊断成像
- 心肺医学 心肺医学
背景情况:
- 在急诊室 (ED) 诊断肺栓塞 (PE) 存在复杂的挑战.
- 目前的诊断策略通常涉及广泛的胸部成像.
- 优化PE诊断对于及时的患者管理至关重要.
研究的目的:
- 审查和总结ED中急性肺栓塞的最佳诊断策略.
- 突出临床表现,决策规则和调查的作用.
- 为PE诊断提供基于证据的方法.
主要方法:
- 对2010年1月1日至2023年9月1日期间发表的研究进行系统审查.
- 对临床表现,决策规则 (PERC,YEARS,PEGeD) 和成像方式的分析.
- 在不同患者群体中评估PE的诊断算法.
主要成果:
- 在患有胸痛,呼吸短促,昏迷或DVT症状的患者中,应该怀疑PE.
- 临床概率评估是最初的步骤,使用PERC规则排除PE.
- 验证的决策规则和D-二分体测试 (YEARS,PEGeD) 有助于管理低至中等概率的案例.
- 高临床概率要求立即进行胸部成像;针对特定人群存在量身定制的方法.
结论:
- 一个概率学,贝叶斯式的方法整合临床评估和验证的规则优化PE诊断.
- 战略性使用决策规则和D-二次体测试可以减少对成像的依赖.
- 针对特定患者群体定制诊断途径可以提高PE管理效率.
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