Akutní plicní embolie - Současný pohled

Akutní plicní embolie se manifestuje širokou škálou příznaků - od šoku nebo setrvalé hypotenze až po pouhou mírnou dyspnoi. Někdy může být plicní embolie dokonce asymptomatická a je diagnostikována některou ze zobrazovacích metod při vyšetření provedeném z jiného důvodu. V závislosti na různých typech klinické manifestace se rovněž uváděná úmrtnost na akutní plicní embolii pohybuje v rozmezí od méně než 1 % po 60 %.1

Základním terapeutickým postupem je u plicní embolie podání antikoagulancií. V závislosti na velikosti odhadovaného rizika špatné prognózy je nutná hospitalizace na jednotce intenzivní péče a léčba trombolýzou, katetrizačními technikami nebo chirurgickou embolektomií, jindy přichází v úvahu časné ukončení hospitalizace nebo dokonce léčba v domácích podmínkách. Tento přehledový článek se pokouší stanovit optimální strategii diagnostiky a léčby v závislosti na klinické manifestaci a odhadovaném riziku nepříznivého výsledku.

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Plnou verzi najdete v Medicíně po promoci číslo 5/2010

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Summary

The clinical presentation of acute pulmonary embolism ranges from shock or sustained hypotension to mild dyspnea. Pulmonary embolism may even be asymptomatic and diagnosed by imaging procedures performed for other purposes. Depending on the clinical presentation, the case fatality rate for acute pulmonary embolism ranges from about 60% to less than 1%. Anticoagulation is the foundation of therapy for pulmonary embolism. Depending on the estimated risk of an adverse outcome, admission to an intensive care unit and treatment with thrombolysis or catheter or surgical embolectomy may be required, but early hospital discharge or even home treatment may be considered. Th is review focuses on the optimal diagnostic strategy and management, according to the clinical presentation and estimated risk of an adverse outcome.

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