Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Chẩn đoán thuyên tắc phổi tại khoa cấp cứu
Tóm tắt
Thuyên tắc phổi (TP) là bệnh lý tim mạch cấp tính phổ biến thứ ba, sau nhồi máu cơ tim và đột quỵ. Việc chẩn đoán TP vẫn còn khó khăn tại các khoa cấp cứu, bắt đầu bằng việc nghi ngờ lâm sàng dựa trên các yếu tố nguy cơ và triệu chứng thường không đặc hiệu. Bước tiếp theo là xác định xác suất trước thử nghiệm của TP thông qua các thang điểm đã được xác thực hoặc thông qua kinh nghiệm lâm sàng. Xác suất này sẽ được tinh chỉnh qua nhiều xét nghiệm chẩn đoán mà cần nắm rõ chỉ định và giới hạn của chúng. Quy trình có hệ thống này cho phép khẳng định hoặc loại trừ trường hợp TP một cách hiệu quả, tránh việc tiêu tốn quá mức các xét nghiệm bổ sung. Công trình của chúng tôi tập trung vào việc xem xét các phương pháp tiếp cận thực tiễn trong chẩn đoán TP tại khoa cấp cứu cho bệnh nhân ổn định về mặt huyết động học.
Từ khóa
#thuyên tắc phổi #chẩn đoán #cấp cứu #hô hấp #huyết động họcTài liệu tham khảo
Giuntini C, Di Ricco G, Marini C, et al (1995) Pulmonary embolism: epidemiology. Chest 107:3S–9S
Tapson VF (2011) Acute pulmonary embolism: comment on “time trends in pulmonary embolism in the United States.” Arch Intern Med 171:837–839
Wiener RS, Schwartz LM, Woloshin S (2013) When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 347:f3368
Calder KK, Herbert M, Henderson SO (2005) The mortality of untreated pulmonary embolism in emergency department patients. Ann Emerg Med 45:302–310
Heit JA, Silverstein MD, Mohr DN, et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a populationbased case-control study. Arch Intern Med 160:809–815
Darze ES, Latado AL, Guimarães AG, et al (2005) Incidence and clinical predictors of pulmonary embolism in severe heart failure patients admitted to a coronary care unit. Chest 128:2576–2580
Zöller B, Li X, Sundquist J, Sundquist K (2012) Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet 379:244–249
Goldhaber SZ, Grodstein F, Stampfer MJ, et al (1997) A prospective study of risk factors for pulmonary embolism in women. JAMA 277:642–645
Stein PD, Beemath A, Matta F, et al (2007) Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 120:871–879
Lucassen W, Geersing G-J, Erkens PM, et al (2011) Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 155:448–460
Wells PS, Anderson DR, Rodger M, et al (2000) Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 83:416–420
Le Gal G, Righini M, Roy PM, et al (2006) Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 144:165–171
Douma RA, Gibson NS, Gerdes VE, et al (2009) Validity and clinical utility of the simplified Wells rule for assessing clinical probability for the exclusion of pulmonary embolism. Thromb Haemost 101:197–200
Klok FA, Mos ICM, Nijkeuter M, et al (2008) Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 168:2131–2136
Ceriani E, Combescure C, Le Gal G, et al (2010) Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 8:957–990
Penaloza A, Mélot C, Motte S (2011) Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism. Thromb Res 127:81–84
Bahia A, Albert RK (2011) The modified Wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis. J Hosp Med 6:190–194
Kline JA, Mitchell AM, Kabrhel C, et al (2004) Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2:1247–1255
Singh B, Parsaik AK, Agarwal D, et al (2012) Diagnostic accuracy of pulmonary embolism rule-out criteria: a systematic review and meta-analysis. Ann Emerg Med 59:517–520
Hugli O, Righini M, Le Gal G, et al (2011) The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism. J Thromb Haemost 9:300–304
Penaloza A, Verschuren F, Dambrine S, et al (2012) Performance of the Pulmonary Embolism Rule-out Criteria (the PERC rule) combined with low clinical probability in high prevalence population. Thromb Res 129:e189–193
Penaloza A, Verschuren F, Meyer G, et al (2013) Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med 62:117–124
Righini M, Perrier A, De Moerloose P, et al (2008) D-Dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost 6:1059–1071
Di Nisio M, Squizzato A, Rutjes AW, et al (2007) Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost 5:296–304
Roy PM, Colombet I, Durieux P, et al (2005) Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 331:259
Raimondi P, Bongard O, de Moerloose P, et al (1993) D-dimer plasma concentration in various clinical conditions: implication for the use of this test in the diagnostic approach of venous thromboembolism. Thromb Res 69:125–130
Sodeck G, Domanovits H, Schillinger M, et al (2007) D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study. Eur Heart J 28:3067–3075
Miron MJ, Perrier A, Bounameaux H, et al (1999) Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients. Eur Respir J 13:1365–1370
Hager K, Platt D (1995) Fibrin degeneration product concentrations (D-dimers) in the course of ageing. Gerontology 41:159–165
Righini M, Goehring C, Bounameaux H, et al (2000) Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 109:357–361
Douma RA, le Gal G, Söhne M, et al (2010) Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ 340:c1475
Van Es J, Mos I, Douma R, et al (2012) The combination of four different clinical decision rules and an age-adjusted D-dimer cutoff increases the number of patients in whom acute pulmonary embolism can safely be excluded. Thromb Haemost 107:167–171
Age-adjusted D-dimer Cut-off Levels to Rule Out Pulmonary Embolism (ADJUST) — NCT01134068. www.ClinicalTrials.gov, consulté le 30 août 2013.
The PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263:2753–279
Anderson DR, Kahn SR, Rodger MA, et al (2007) Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 298:2743–2753
Hall WB, Truitt SG, Scheunemann LP, et al (2009) The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 169:1961–1965
Masuda EM, Kistner RL, Musikasinthorn C, et al (2012) The controversy of managing calf vein thrombosis. J Vasc Surg 55: 550–561
Sheiman RG, McArdle CR (1999) Clinically suspected pulmonary embolism: use of bilateral lower extremity US as the initial examination—a prospective study. Radiology 212:75–78
Kearon C, Ginsberg JS, Hirsh J (1998) The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med 129:1044–1049
Righini M, Le Gal G, Aujesky D, et al (2008) Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 371:1343–1352
Stein PD, Fowler SE, Goodman LR, et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327
Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F (2005) Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. Eur Radiol 15:2057–2063
Ginsberg MS, King V, Panicek DM (2004) Comparison of interpretations of CT angiograms in the evaluation of suspected pulmonary embolism by on-call radiology fellows and subsequently by radiology faculty. Am J Roentgenol 182:61–66
Stein PD, Terrin ML, Hales CA, et al (1991) Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 100:598–603
Rodger MA, Carrier M, Jones GN, et al (2000) Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med 162:2105–2108
Rodger M, Makropoulos D, Turek M, et al (2000) Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 86:807–809
Douketis JD, Crowther MA, Stanton EB, et al (2002) Elevated cardiac troponin levels in patients with submassive pulmonary embolism. Arch Intern Med 162:79–81.
Sanchez O, Trinquart L, Caille V, et al (2010) Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study. Am J Respir Crit Care Med 181:168–173
Green SM, Yealy DM (2012) Right-sizing testing for pulmonary embolism: recognizing the risks of detecting any clot. Ann Emerg Med 59:524–526
Perrier A, Roy P-M, Sanchez O, et al (2005) Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 352:1760–1768
Van Belle A, Büller HR, Huisman MV, et al (2006) Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 295:172–179
Roy P-M, Durieux P, Gillaizeau F, et al (2009) A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med 151:677–686
Drescher FS, Chandrika S, Weir ID, et al (2011) Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism. Ann Emerg Med 57:613–621
Kyrle PA, Eichinger S (2008) New diagnostic strategies for pulmonary embolism. Lancet 371:1312–1315.
Kline JA, Williams GW, Hernandez-Nino J (2005) D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 51:825–859
To MS, Hunt BJ, Nelson-Piercy C (2008) A negative D-dimer does not exclude venous thromboembolism (VTE) in pregnancy. J Obstet Gynaecol 28:222–223
Cook JV, Kyriou J (2005) Radiation from CT and perfusion scanning in pregnancy. BMJ 331:350
Leung AN, Bull TM, Jaeschke R, et al (2012) American Thoracic Society documents: an official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline—Evaluation of Suspected Pulmonary Embolism in Pregnancy. Radiology 262: 635–646
Kearon C, Akl EA, Comerota AJ, et al (2012) Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e419S–e494S.
Bates SM, Greer IA, Middeldorp S, et al (2012) VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e691S–e736S.