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确定肺血栓栓塞症(pulmonarythromboembolism,PTE)的诊断策略是为了更合理地安排不同检查手段,简化诊断步骤,缩短确诊所需时间,避免遗漏检查项目,减少有创检查可能带来的并发症,降低医疗费用,并最终达到提高诊断效率,选择合适治疗方案的目的。在欧美,PTE的诊断策略很多,国内中华医学会呼吸分会也于2001年在《肺血栓栓塞症的诊断与治疗指南(草案)》中提出了疑诊、确诊和求因三个诊断步骤,并对每个步骤中所包含的不同检查方法的诊断价值做出科学的评价。其思维框架简单明了,可操作性和实用性强,适用范围广,是目前比较适合国内情况的诊断策略。引起PTE的血栓可以来源于下腔静脉、上腔静脉径路或右心腔,其中大部分来源于下肢静脉,因此在临床诊断工作中应重视二者的联系。
The diagnostic strategy to determine pulmonary thromboembolism (PTE) is to arrange different examinations more reasonably, to simplify the diagnostic procedure, to shorten the time required for the diagnosis, to avoid missing the examination items, to reduce the possible complications caused by the invasive examination and to reduce the complications Medical expenses, and ultimately to improve the diagnostic efficiency, the purpose of selecting the appropriate treatment. In Europe and the United States, there are many diagnostic strategies for PTE. The respiratory branch of the Chinese Medical Association has also put forward three diagnostic steps in 2004 for the diagnosis and treatment of pulmonary thromboembolism (Draft) Make a scientific assessment of the diagnostic value of the different test methods included in each step. Its simple and clear thinking framework, practicality and practicality, wide range of applications, is currently more suitable for domestic diagnostic strategies. The thrombus caused by PTE can originate from the inferior vena cava, the superior vena cava, or the right ventricle, most of which originate from the veins of the lower extremity. Therefore, the connection between the two should be emphasized in clinical diagnosis.