2018版中国《肺血栓栓塞症诊治与预防指南》解读之四：特殊情况下肺血栓栓塞症的处理.pdfVIP

2018版中国《肺血栓栓塞症诊治与预防指南》 解读之四：特殊情况下肺血栓栓塞症的处理 1，2 1，2 2 张  竹 ，王增慧 ，高  倩 摘要 ：肺血栓栓塞症(PTE)作为一种多学科疾病，由于其症状缺乏特异度易被漏诊及误诊。急性PTE的处理所需 面对的情况复杂多样。新版指南针对6种常见的特殊情况进行了详细的论述，包括妊娠合并PTE、恶性肿瘤合并 PTE、PTE合并活动性出血、围手术期PTE、PTE合并右心血栓、血小板减少合并PTE等。尽管这6种情况无法覆盖 所有特殊情况，但相信能在临床中将给广大医务工作者带来启示。 关键词 ：特殊类型肺血栓栓塞症；治疗原则；预防策略 中图分类号：R543.2　文献标识码：A Interpretation of the guidelines on the diagnosis, management and prevention of pulmonary thromboembolism: pulmonary thromboembolism treatment under special conditions. ZHANG Zhu*, WANG Zeng-hui, GAO Qian. *Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases; Chinese Academy of Medical Sciences, Peking Union Medical, Beijing 100029, China Corresponding author: GAO Qian, E-mail: gaoqian@bjmu.edu.cn Abstract: Pulmonary thromboembolism (PTE), as a multidisciplinary disease, is easily missed and misdiagnosed. The conditions with PTE are complex and diverse. The new guideline discusses six common special cases in detail, including: pregnancy with PTE, malignancy with PTE, PTE with active bleeding, perioperative PTE, PTE with right heart thrombus, and thrombocytopenia combined with PTE. Although these six conditions cannot cover all clinical special situations, it will provide some hints for the majority of doctors in the clinic. Keywords: venous thromboembolism in special population; treatment principle; thromboprophylaxis 高倩，医学博士、主治医师，中 对于某些特殊临床情况，并不存在固定的方案。因 日医院第一批呼吸与危重症医学科 此，临床医生在实践中会面临许多困境，对于治疗决 (PCCM)专科医师培训毕业生，中日医 策会存在疑惑。2018 版 《肺血栓栓塞症诊治与预防 院院士工作室成员。参与十三五国家 指南》 ( 以下简称“新版指南”) 针对常见的 6 种特殊 重点研发计划，参编 《呼吸疑难少见病