肺栓塞的诊治进展

Advances in the Diagnosis and Treatment of Pulmonary Embolism

摘要: 肺栓塞(Pulmonary Embolism, PE)是继卒中和心肌梗死之后全球第三大常见可导致死亡的心血管疾病，最近10年PE在我国的发病率不断上升，由于其潜在的致死风险，临床医师在危重PE的管理上需要保持高度警惕。近年来在PE的诊断和治疗方面取得了一些重要进展，结合临床评分、影像学和实验室指标进行风险分层是对PE进行高质量管理的关键。目前，抗凝和全身溶栓是应用最为广泛的治疗方式，但对于中危或者高危PE患者，经皮介入治疗呈现出更精准的疗效和相对小的出血风险。除此之外肺栓塞快速反应团队(Pulmonary Embolism Response Team, PERT)理念在部分医疗中心的实施也为PE的快速诊断、风险评估及紧急救治提供了完善的诊治流程。本文总结了国内外有关PE诊断及治疗的最新研究进展，旨在为PE的高质量管理提供新思路，进一步精准快速地识别高风险PE，优化治疗策略。

Abstract: Pulmonary Embolism (PE) is the third most common fatal cardiovascular disease worldwide following stroke and myocardial infarction. The incidence of PE in China has been on a steady rise over the past decade. Given its potential life-threatening risk, clinicians must maintain a high level of vigilance in the management of high-risk PE. In recent years, significant advances have been made in the diagnosis and treatment of PE, and risk stratification combining clinical scores, imaging and laboratory indicators has become the key to high-quality PE management. At present, anticoagulation and systemic thrombolysis remain the most widely used therapeutic approaches, yet for intermediate-risk or high-risk PE patients, percutaneous interventional therapy offers more precise efficacy with a relatively lower bleeding risk. In addition, the implementation of the Pulmonary Embolism Response Team (PERT) concept in some medical centers has provided a well-established diagnostic and therapeutic process for the rapid diagnosis, risk assessment and emergency treatment of PE. This paper summarizes the latest research advances in the diagnosis and treatment of PE at home and abroad, aiming to provide new insights for the high-quality management of PE, further identify high-risk PE accurately and rapidly, and optimize therapeutic strategies.