循環器ジャーナル65巻1号

2017年01月発行

特集 Clinical Scenarioによる急性心不全治療 Ⅶ．Clinical Scenario 5：右心不全

急性肺血栓塞栓症についてのエビデンス

著者： 熊谷英太¹ 福本義弘¹

所属機関： ¹久留米大学医学部内科学講座心臓・血管内科部門

ページ範囲：P.125 - P.131

Point
・急性肺血栓塞栓症は，血栓による機械的閉塞と神経液性因子によりショック状態に陥る．
・わが国の急性肺血栓塞栓症の発症数は欧米より少ないとされるが十分な調査がされていないのも実情である．
・急性肺血栓塞栓症が疑わしい場合は過剰診断を恐れずに検査することが大事である．

参考文献

1) Lowe GD:Virchow's triad revisited:abnormal flow. Pathophysiol Haemost Thromb 33:455-457, 2003

2) Bertina RM, Koeleman BP, Koster T, et al:Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 369:64-67, 1994

3) De Stefano V, Chiusolo P, Paciaroni K, et al:Epidemiology of factor V Leiden:clinical implications. Semin Thromb Hemost 24:367-379, 1998

4) 長谷川淳，長田　博，山内雅夫，他：肺血栓・塞栓・梗塞症の疫学（続）．日胸臨8:677-681, 1981

5) 三重野龍彦，青木茂行，吉良枝郎：肺血栓塞栓症：本邦における肺血栓塞栓症の疫学的検討．日胸疾患会誌26:448-456, 1988

6) Freiman DG, Suyemoto J, Wessler S:Frequency of pulmonary thromboembolism in man. New Engl J Med 272:1278-1280, 1965

7) Morrell MT, Dunnill MS:The post-mortem incdence of pulmonary embolism in a hospital population. Br J Surg 55:347-352, 1968

8) 中野　赳，伊藤早苗，竹沢英郎：肺塞栓症の疫学．医事新報2949:43-47, 1980

9) Kumasaka N, Sakuma M, Shirato K:Incidence of pulmonary thromboembolism in Japan. Jpn Circ J 63:439-441, 1999

10) Kitamukai O, Sakuma M, Takahashi T, et al:Incidence and characteristics of pulmonary thromboembolism in Japan 2000. Intern Med 42:1090-1094, 2003

11) Silverstein MD, Heit JA, Mohr DN, et al:Trends in the incidence of deep vein thrombosis and pulmonary embolism:a 25-year population-based study. Arch Intern Med 23:585-593, 1998

12) Klatsky AL, Armstrong MA, Poggi J:Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 85:1334-1337, 2000

13) Nakamura M, Fujioka H, Yamada N, et al:Clinical characteristics of acute pulmonary thromboembolism in Japan:results of a multicenter registry in the Japanese Society of Pulmonary Embolism Research. Clin Cardiol 24:132-138, 2001

14) 黒岩政之，古家　仁，瀬尾憲正，他：本邦における周術期肺塞栓症の発症頻度とその特徴：2002年度周術期肺血栓塞栓症発症調査報告—(社)日本麻酔科学会肺血栓塞栓症予防ガイドライン作成作業部会報告—．麻酔53:454-463, 2004

15) 黒岩政之，古家　仁，瀬尾憲正，他：2003年周術期肺血栓塞栓症発症アンケート調査結果からみた本邦における発症頻度とその特徴—(社)日本麻酔科学会肺塞栓症研究ワーキンググループ報告—．麻酔54:822-828, 2005

16) 黒岩政之，古家　仁，瀬尾憲正，他：2004年周術期肺塞栓症発症調査結果からみた本邦における周術期肺血栓塞栓症発症頻度とその特徴—(社)日本麻酔科学会肺塞栓症研究ワーキンググループ報告—．麻酔55:1031-1038, 2006

17) 黒岩政之，古家　仁，瀬尾憲正，他：2005-2007年周術期肺塞栓症発症調査結果から見た本邦における周術期肺血栓塞栓症の特徴—(社)日本麻酔科学会安全委員会肺血栓塞栓症ワーキンググループ報告—．麻酔58:1567-1573, 2009

18) 黒岩政之，古家　仁，瀬尾憲正，他：本邦における周術期肺塞栓症の発症頻度とその特徴2008年度周術期肺血栓塞栓症発症調査報告—(社)日本麻酔科学会肺血栓塞栓症予防ガイドライン作成作業部会報告—．麻酔59:667-673, 2010

19) Sakuma M, Okada O, Nakamura M, et al:Recent developments in diagnostic imaging techniques and management for acute pulmonary embolism:multicenter registry by the Japanese Society of Pulmonary Embolism Research. Intern Med 42:470-476, 2003

20) Watanabe J, Iwabuchi K, Koseki Y, et al:Declining trend in the in-hospital case-fatality rate from acute myocardial infarction in Miyagi Prefecture from 1980 to 1999. Jpn Circ J 65:941-946, 2001

21) Anderson FA Jr, Wheeler HB, Goldberg RJ, et al:A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 151:933-938, 1991

22) Miniati M, Prediletto R, Formichi B, et al:Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 159:864-871, 1999

23) Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J 21:1301-1336, 2000

24) Worsley DF, Alavi A, Aronchick JM, et al:Chest radiographic findings in patients with acute pulmonary embolism:observations from the PIOPED Study. Radiology 189:133-136, 1993

25) Richman PB, Loutfi H, Lester SJ, et al:Electrocardiographic findings in Emergency Department patients with pulmonary embolism. J Emerg Med 27:121-126, 2004

26) Kosuge M, Kimura K, Ishikawa T, et al:Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes on the basis of negative T waves. Am J Cardiol 99:817-821, 2007

27) Kosuge M, Kimura K, Ishikawa T, et al:Prognostic significance of inverted T waves in patients with acute pulmonary embolism. Circ J 70:750-755, 2006

28) Dunn KL, Wolf JP, Dorfman DM, et al:Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism. J Am Coll Cardiol 16:1475-1478, 2002

29) Konstantinides S, Geibel A, Olschewski M, et al:Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 106:1263-1268, 2002

30) Morrow DA, de Lemos JA, Blazing MA, et al:Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease. JAMA 294:2866-2871, 2005

31) McConnell MV, Solomon SD, Rayan ME, et al:Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 78:469-473, 1996

32) Goldhaber SZ, Visani L, De Rosa M:Acute pulmonary embolism:clinical outcomes in the International Cooperative Pulmonary Embolism Registry（ICOPER). Lancet 353:1386-1389, 1999

33) Ribeiro A, Lindmarker P, Juhlin-Dannfelt A, et al:Echocardiography Doppler in pulmonary embolism:right ventricular dysfunction as a predictor of mortality rate. Am Heart J 134:479-487, 1997

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

35) PIOPED Investigators:Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis（PIOPED). JAMA 263:2753-2759, 1990

36) 小野文明，京谷晋吾，中西宣文：当院で経験した急性肺血栓塞栓症例の長期予後と危険因子．Ther Res 29:775-778, 2008

37) Goldhaber SZ, Morpurgo M:Diagnosis, treatment, and prevention of pulmonary embolism. Report of the WHO/International Society and Federation of Cardiology Task Force. JAMA 268:1727-1733, 1992

38) Barritt DW, Jordan SC:Clinical features of pulmonary embolism. Lancet 1:729-732, 1961