PATE (plaučių arterijų trombinė embolija) – didžiulė šiuolaikinės medicinos problema. Staigi plaučių arterijos šakų okliuzija gali lemti ūminį, gyvybei grėsmingą, bet potencialiai grįžtamą dešiniojo skilvelio nepakankamumą.
Diagnozę nustatyti yra sunku, dalis atvejų lieka neatpažinti. Negydomų ligonių mirštamumas siekia 30 proc., bet, nustačius diagnozę ir skyrus tinkamą gydymą antikoaguliantais, jis sumažėja iki 2–8 proc.
PATE dažnu atveju yra sunkios pagrindinės ligos nulemta mirtinos baigties priežastis.
Paklausykite PODCAST apie PATE diagnostiką. Kaip? Ką? ir Kada? reikia daryti, kad išvengtume hiperdiagnostikos ir neišleistume į namus paciento kuriam pasireiškė PATE.
Žemiau pateiktas visų veiksmų, reikalingų PATE diagnostikai algoritmas, kuris buvo sudarytas vadovaujantis naujausiomis rekomendacijomis ir patvirtintas LSMUL KK SPS skyriuje.
VELSO Kriterijai |
Balas |
Buvusi giliųjų venų trombozė arba PE |
1,5 |
Neseniai buvusi operacija ar imobilizacija (4 sav.) |
1,5 |
Aktyvi piktybinė liga |
1 |
Kraujo atkosėjimas |
1 |
ŠSD >100 k./min. |
1,5 |
Giliųjų kojų venų trombozės klinikiniai simptomai |
3 |
Kliniškai labiausiai tikėtina PE |
3 |
* PATE mažai tikėtina 0–4
* PATE didelė tikimybė >4
PERC score naudojamas, kai nustatoma maža rizika taikant VELSO kriterijus.
Jei atsakote nors į vieną teiginį ne –> atliekate D-dimerų tyrimą, jei į visus teiginius atsakote TAIP –> D-dimerų tyrimo atlikti nereikia.
PERC score:
- Amžius < 50 metų;
- ŠSD < 100 k/min;
- SpO2 > 94 proc.;
- Nėra vienos kojos patinimo;
- Neatkosti kraujo;
- Nebuvo operacijos 1 mėn. laikotarpiu;
- Nėra buvę GVT ar PE;
- Nevartoja hormonų per/os;
SM Gyd. rez. Eglė Zelbienė
Naudota literatūra:
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- The Pulmonary Embolism Severity Index (PESI) and mortality by total point score. American Thoracic Society. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. American Journal of Respiratory and Critical Care Medicine. 2005;172:1041-1046. Official journal of the American Thoracic Society, Diane Gern, Publisher.
- Moser KM, Fedullo PF, LitteJohn JK, et al. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA. 1994;271:223-225.
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- Runyon MS, Webb WB, Jones AE, et al. Comparison of the unstructured clinician estimate of pretest probability for pulmonary embolism to the Canadian score and the Charlotte rule: a prospective observational study. Acad Emerg Med. 2005; 12:587-593.
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- Le Gal G, Righini M, Roy P-M, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165-171.
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- Nordenholz KE, Naviaux NW, Stegelmeier K, et al. Pulmonary embolism risk assessment screening tools: the interrater reliability of their criteria. Am J Emerg Med. 2007;25:285-290.
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- Kline JA, Mitchell AM, Kabrhel C, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2:1247-1255
- http://www.pulmoalerg.lt/files/leidiniai/plauciu_embolija.pdf
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