全杨波 柴燕玲

【摘要】肺栓塞是指各種内源性火外源性栓子堵塞肺动脉或其分支引发肺循环功能障碍的一系列临床和病理生理综合征，其栓子可以是羊水、空气、血栓等。肺血栓栓塞是最常见的急性肺栓塞类型，占急性肺栓塞的绝大多数，是指由静脉系统或有新的血栓堵塞肺动脉或其分支引起的疾病[1]，主要的临床表现为：呼吸困难、胸痛、咯血、晕厥等[2]。是呼吸科危重症疾病之一，如不及时治疗，死亡率极高。目前我国的治疗方法有抗凝治疗、溶栓治疗、介入及手术治疗，虽然我国急性肺血栓栓塞诊断率明显上升，但因医疗条件水平限制，很多地方仅能药物治疗，本文检索了急性肺栓塞药物治疗的相关文献，详细阐述了根据急性肺血栓栓塞危险分层选择不同药物治疗现状及进展。

【关键词】急性肺血栓栓塞 危险分层 药物治疗 现状及进展

【中图分类号】R749 【文献标识码】A 【文章编号】2026-5328（2021）08-090-03

Abstract：Pulmonary embolism refers to a series of clinical and pathophysiological syndromes in which various endogenous and exogenous emboli block the pulmonary artery or its branches and cause pulmonary circulatory dysfunction. The emboli can be amniotic fluid，air，thrombus and so on. Pulmonary thromboembolism is the most common type of acute pulmonary embolism，which accounts for the vast majority of acute pulmonary embolism. It refers to the disease caused by venous system or new thrombus blocking pulmonary artery or its branches [1]. The main clinical manifestations are dyspnea，chest pain，hemoptysis，syncope and so on [2]. It is one of the critically ill diseases in respiratory department. If it is not treated in time，the mortality rate is extremely high. At present，there are anticoagulant therapy，thrombolytic therapy，interventional therapy and surgical treatment in our country. Although the diagnostic rate of acute pulmonary thromboembolism has increased obviously in our country，due to the limitation of medical conditions，many places can only be treated with drugs. This paper retrieves the relevant literature on drug treatment of acute pulmonary embolism，and expounds in detail the present situation and progress of selecting different drugs according to the risk stratification of acute pulmonary thromboembolism.

Key words：acute pulmonary thromboembolism;hazard stratification;drug treatment;present situation and progress

1急性肺栓的危险分层

1.1分层意义：对患者进行危险分层的意义在于评估患者短期死亡风险（院内死亡或30d死亡）及选择诊疗手段[3]

1.2危险分层及早期死亡风险分类[4]

1.2.1 PESI：肺栓塞严重指数：分组项目年龄、男性、肿瘤、慢性心力衰竭、慢性肺部疾病、精神状态改变、脉搏≥110次/分（1mmHg=0.133kPa）、呼吸频率≥30次/分、体温<36℃、动脉血氧饱和度<90%。评分标准：分为低危（Ⅰ-Ⅱ级）、中危（Ⅲ、Ⅳ）、高危（Ⅴ）[5]。

12.2 Spesi，简化版肺栓塞严重指数：高龄（>80岁）、癌症、心力衰竭或慢性肺部疾病史、收缩压≤100mmHg（1mmHg=0.133kPa）、心率>100次/分及动脉血氧饱和度≤90%。0分为低位，30s病死率在1.0%;任何阳性为高危，30d病死率在10.9%[6]。……