medicina58巻4号

2021年04月発行

増刊号 救急診療　好手と悪手

循環器系

肺血栓塞栓症—ガイドラインに則り，適切に診断しよう

著者： 大前奈菜¹ 髙橋仁¹

所属機関： ¹東京ベイ浦安・市川医療センター救急集中治療科

ページ範囲：P.68 - P.72

文献概要

こんな対応は悪手
①若年の呼吸困難で肺塞栓を疑わない
②Wells Criteriaで高リスクにもかかわらずD-dimerを測定する
③年齢によるD-dimerのカットオフ値を知らない
④循環動態が不安定な患者にD-dimerを測定する

参考文献

1）Stein PD, et al：Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 100：598-603, 1991

2）Castelli R, et al：Syncope in patients with pulmonary embolism；Comparison between patients with syncope as the presenting symptom of pulmonary embolism without syncope. Vasc Med 8：257-261, 2003

3）Silverstein MD, et al：Trends in the incidence of deep vein thrombosis and pulmonary embolism；A 25-year population-based study. Arch Intern Med 158：585-593, 1998

4）Naess IA, et al：Incidence and mortality of venous thrombosis；A population-based study. J Thromb Haemost 5：692-699, 2007

5）Simpson EL, et al：Venous thromboembolism in pregnancy and the puerperium；Incidence and additional risk factors from a London perinatal database. BJOG 108：56-60, 2001

6）Ota S, et al：Incidence, characteristics and management of venous thromboembolism in Japan during 2011. Circ J 82：555-560, 2018

7）Roy PM, et al：Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med 144：157-164, 2006

8）Konstantinides SV, et al：2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society. Eur Heart J 41：543-603, 2020

9）Wells PS, et al：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, 2000

10）Kline JA, et al：Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 6：772-780, 2008

11）Raja AS, et al：Evaluation of patients with suspected acute pulmonary embolism；Best practice advice from the clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 163：701-711, 2015

12）Stein PD, et al：Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354：2317-2327, 2006

13）Righni M, et al：Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism；The ADJUST-PE Study. JAMA 311：1117-1124, 2014

14）van der Hulle T, et al：Simplified diagnostic management of suspected pulmonary embolism（the YEARS study）；A prospective, multicentre, cohort study. Lancet 390：289-297, 2017

15）Kurzyna M, et al：Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. Am J Cardiol 90：507-511, 2002

16）Le Gal G, et al：A positive compression ultrasonography of the lower limb veins is highly predictive of pulmonary embolism on computed tomography in suspected patients. Thromb Haemost 95：963-966, 2006