急性肺血栓栓塞症规范化诊断治疗_黄岚.ppt

* 我的汇报结束，谢谢各位专家 Standardized diagnosis and treatment Assessment of clinical probability Recommendation of selecting diagnostic tests European Heart Journal, 2008 Patient with dyspnea, chest pain, haemoptysis and tachyrhythmia, especially combined with predisposing factors of PE should be assessed Frequently used clinical prediction rules ---- Wells score and the revised Geneva score 1. Assessment of clinical probability Revised Geneva score Variable Points Predisposing Age 65 years factors Previous DVT or PE Surgery or fracture within 1 month Active malignancy +1 +3 +2 +2 Symptoms Unilateral lower limb pain Haemoptysis +3 +2 Clinical Heart rate 75-94 beats/min signs Heart rate ≥95 beats/min Pain on lower limb deep vein at Palpation and unilateral oedema +3 +5 +4 Clinical probability Low Intermediate High Total 0-3 4-10 ≥11 Wells score Variable Points Predisposing Previous DVT or PE Recent surgery or immobilization Cancer +1.5 +1.5 +1 Symptoms Haemoptysis +1 Clinical Heart rate 100 beats/min signs Clinical signs of DVT +1.5 +3 Clinical probability（3 levels） Low Intermediate High Total 0-1 2-6 ≥7 Clinical probability（2 levels） PE unlikely PE likely Total 0-4 4 Both rules are simple and based on easily collected information Incidence of PE 10% ---- low Incidence of PE ≈ 30% ---- intermediate Incidence of PE 65% ---- high 2. Recommendation of diagnostic tests To select reasonable diagnostic tests according to clinical probability and clinical presentation of suspected