慢性血栓栓塞性肺高血压的诊断
Xavier Jais1, Victor Tapson2, Timothy M Fernandes3
1AP-HP, Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, University of Paris-Saclay, Le Kremlin-Bicêtre, France.
概括
慢性血栓栓塞性肺高血压 (CTEPH) 是肺栓塞 (PE) 的严重并发症. 早期诊断和专家中心转诊对于管理CTEPH和改善患者结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 血管医学 血管医学
背景情况:
- 慢性血栓栓塞性肺高血压 (CTEPH) 是一种严重的并发症,影响2.7%的肺栓塞 (PE) 幸存者.
- 它源于由纤维血栓和二次微血管病变引起的持续性肺动脉阻塞,导致肺血管抵抗力增加和右心力衰竭.
- 慢性炎症,纤维分解受损和凝血异常等机制阻碍了PE解决.
研究的目的:
- 定义慢性血栓栓塞性肺病 (CTEPD) 和慢性血栓塞性肺高血压 (CTEPH).
- 概述CTEPH的诊断标准和成像方法.
- 强调早期转诊到专家中心进行诊断和治疗的重要性.
主要方法:
- 在患有PE后持续性呼吸障碍或肺高血压 (PH) 的患者中,在通风/ perfusion 肺部扫描上显示出不匹配的 perfusion 缺陷,怀疑诊断.
- 确认包括全面的右心导管和高级成像 (CT肺血管造影,数字减去血管造影).
- 评估应在专门的CTEPH中心进行.
主要成果:
- 在患有慢性血栓栓塞性疾病的患者中,CTEPH诊断需要有肺高血压的证据.
- 具体的成像发现和血液动力学测量是确认的关键.
- 专家中心的评估对于准确的诊断至关重要.
结论:
- 早期向具有多学科团队的专家中心转诊对于准确的CTEPH诊断至关重要.
- 专家中心的定制治疗策略改善了CTEPH患者的治疗结果.
- 了解不完整的PE解决方案的潜在机制是一个正在进行的研究领域.
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