2018年新版《肺血栓栓塞症诊治与预防指南》的解读与思考——以循证医学指南指导临床实践
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摘要
肺血栓栓塞症(pulmonary thromboembolism,PTE)具有高发病率、高病死率和高致残率的特点,是严重威胁人类健康的重大医疗问题。近年来PTE领域相关研究发展迅速,已有的指南不能完全满足中国临床医师的诊治需要。鉴此,为更好地指导我国医师的临床实践,中华医学会呼吸病学分会肺栓塞与肺血管病学组、中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会基于当前的循证医学证据,制订了《肺血栓栓塞症诊治与预防指南》。该文将对新版指南进行详尽解读。
Pulmonary thromboembolism(PTE) is characterized by high incidence,high mortality and high disability rates.It is a major medical problem that seriously threatens human health.In recent years,related researches in the field of PTE have developed rapidly,and the existing guidelines are unable to fully meet the clinical needs of Chinese clinicians,based on which the guideline for the diagnosis and treatment and prevention of pulmonary thromboembolism is developed by Pulmonary Embolism and Pulmonary Vascular Diseases Group of Chinese Thoracic Society and Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians to better guide the clinical practice of Chinese physicians.In this paper,we provide a detailed interpretation of the guideline for the diagnosis and treatment and prevention of pulmonary thromboembolism(the 2018 new edition).
Pulmonary thromboembolism(PTE) is characterized by high incidence,high mortality and high disability rates.It is a major medical problem that seriously threatens human health.In recent years,related researches in the field of PTE have developed rapidly,and the existing guidelines are unable to fully meet the clinical needs of Chinese clinicians,based on which the guideline for the diagnosis and treatment and prevention of pulmonary thromboembolism is developed by Pulmonary Embolism and Pulmonary Vascular Diseases Group of Chinese Thoracic Society and Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians to better guide the clinical practice of Chinese physicians.In this paper,we provide a detailed interpretation of the guideline for the diagnosis and treatment and prevention of pulmonary thromboembolism(the 2018 new edition).
引文
1 Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(45):3145-3146.
2 Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e419S-e496S.
3 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149(2):315-352.
4中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南(草案)[J].中华结核和呼吸杂志,2001,24(5):259-264.
5中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087.
6 Guyatt G,Oxman AD,Akl EA,et al.GRADE guidelines:1.Introduction-GRADE evidence profiles and summary of findings tables[J].J Clin Epidemiol,2011,64(4):383-394.
7 Stevens SM,Ansell JE.Thrombophilic Evaluation in Patients with A-cute Pulmonary Embolism[J].Semin Respir Crit Care Med,2017,38(1):107-120.
8 Wang C,Zhai Z,Yang Y,et al.Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism:a randomized,multicenter,controlled trial[J].Chest,2010,137(2):254-262.
9 Zhang Z,Zhai ZG,Liang LR,et al.Lower dosage of recombinant tissue-type plasminogen activator(rt-PA)in the treatment of acute pulmonary embolism:a systematic review and meta-analysis[J].Thromb Res,2014,133(3):357-363.
10 Le Gal G,Kercret G,Ben Yahmed K,et al.Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis:prospective study[J].BMJ,2012,344:e2635.
11 Romualdi E,Dentali F,Rancan E,et al.Anticoagulant therapy for venous thromboembolism during pregnancy:a systematic review and a meta-analysis of the literature[J].J Thromb Haemost,2013,11(2):270-281.
12 Douma RA,van Sluis GL,Kamphuisen PW,et al.Clinical decision rule and D-dimer have lower clinical utility to exclude pulmonary embolism in cancer patients.Explanations and potential ameliorations[J].Thromb Haemost,2010,104(4):831-836.
13 Wysokinski WE,Mc Bane RD,Daniels PR,et al.Periprocedural anticoagulation management of patients with nonvalvular atrial fibrillation[J].Mayo Clin Proc,2008,83(6):639-645.
14 Athappan G,Sengodan P,Chacko P,et al.Comparative efficacy of different modalities for treatment of right heart thrombi in transit:a pooled analysis[J].Vasc Med,2015,20(2):131-138.
2 Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e419S-e496S.
3 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149(2):315-352.
4中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南(草案)[J].中华结核和呼吸杂志,2001,24(5):259-264.
5中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087.
6 Guyatt G,Oxman AD,Akl EA,et al.GRADE guidelines:1.Introduction-GRADE evidence profiles and summary of findings tables[J].J Clin Epidemiol,2011,64(4):383-394.
7 Stevens SM,Ansell JE.Thrombophilic Evaluation in Patients with A-cute Pulmonary Embolism[J].Semin Respir Crit Care Med,2017,38(1):107-120.
8 Wang C,Zhai Z,Yang Y,et al.Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism:a randomized,multicenter,controlled trial[J].Chest,2010,137(2):254-262.
9 Zhang Z,Zhai ZG,Liang LR,et al.Lower dosage of recombinant tissue-type plasminogen activator(rt-PA)in the treatment of acute pulmonary embolism:a systematic review and meta-analysis[J].Thromb Res,2014,133(3):357-363.
10 Le Gal G,Kercret G,Ben Yahmed K,et al.Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis:prospective study[J].BMJ,2012,344:e2635.
11 Romualdi E,Dentali F,Rancan E,et al.Anticoagulant therapy for venous thromboembolism during pregnancy:a systematic review and a meta-analysis of the literature[J].J Thromb Haemost,2013,11(2):270-281.
12 Douma RA,van Sluis GL,Kamphuisen PW,et al.Clinical decision rule and D-dimer have lower clinical utility to exclude pulmonary embolism in cancer patients.Explanations and potential ameliorations[J].Thromb Haemost,2010,104(4):831-836.
13 Wysokinski WE,Mc Bane RD,Daniels PR,et al.Periprocedural anticoagulation management of patients with nonvalvular atrial fibrillation[J].Mayo Clin Proc,2008,83(6):639-645.
14 Athappan G,Sengodan P,Chacko P,et al.Comparative efficacy of different modalities for treatment of right heart thrombi in transit:a pooled analysis[J].Vasc Med,2015,20(2):131-138.