疾病与历史
深静脉血栓脱落后经心脏进入肺动脉形成栓塞。长途飞行、术后卧床都是高危场景。1850年代魏尔肖提出“栓塞”一词;1960年Barritt与Jordan首次用对照试验证明抗凝治疗的价值。
症状与诊断
典型表现为突发气促、吸气时加重的胸痛、心慌、晕厥和咯血,容易与肺炎或心衰混淆。医生用Wells评分(Wells et al., 2000)、PERC标准(Kline et al., 2004)和D-二聚体评估,CT肺动脉造影确诊。
治疗与预防
治疗以抗凝为主,指南优先推荐直接口服抗凝药而非华法林,通常至少3个月(Kearon et al., 2016; Stevens et al., 2021);休克等高危患者可溶栓。长途出行每1至2小时起身活动并多喝水。
本文为一般健康信息,不能代替诊断或治疗。如症状持续,请咨询医生。
常见问题
- 能治好吗?
- 多数经抗凝可康复,但部分会复发或遗留慢性肺动脉高压。
- 坐飞机一定会得吗?
- 不会,但风险升高,应多活动。
来源核查日期:2026-11-02
参考文献
- Konstantinides, S. V., Meyer, G., Becattini, C., Bueno, H., Geersing, G.-J., Harjola, V.-P., Huisman, M. V., Humbert, M., Jennings, C. S., Jiménez, D., Kucher, N., Lang, I. M., Lankeit, M., Lorusso, R., Mazzolai, L., Meneveau, N., Ní Áinle, F., Prandoni, P., Pruszczyk, P., ... Zamorano, J. L. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 41(4), 543–603. 欧洲心脏病学会关于诊断、分层与治疗的指南。
- Wells, P. S., Anderson, D. R., Rodger, M., Ginsberg, J. S., Kearon, C., Gent, M., Turpie, A. G., Bormanis, J., Weitz, J., Chamberlain, M., Bowie, D., Barnes, D., & Hirsh, J. (2000). Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: Increasing the models utility with the SimpliRED D-dimer. Thrombosis and Haemostasis, 83(3), 416–420. 肺栓塞Wells评分的原始论文。
- Kline, J. A., Mitchell, A. M., Kabrhel, C., Richman, P. B., & Courtney, D. M. (2004). Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis, 2(8), 1247–1255. 建立PERC排除标准的研究。
- The PIOPED Investigators. (1990). Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA, 263(20), 2753–2759. 验证通气/灌注扫描准确性的里程碑研究。
- Barritt, D. W., & Jordan, S. C. (1960). Anticoagulant drugs in the treatment of pulmonary embolism: A controlled trial. The Lancet, 275(7138), 1309–1312. 首个肺栓塞抗凝治疗对照试验。
- Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., Huisman, M., King, C. S., Morris, T. A., Sood, N., Stevens, S. M., Vintch, J. R. E., Wells, P., Woller, S. C., & Moores, L. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149(2), 315–352. 推荐直接口服抗凝药的CHEST指南。
- Stevens, S. M., Woller, S. C., Kreuziger, L. B., Bounameaux, H., Doerschug, K., Geersing, G.-J., Huisman, M. V., Kearon, C., King, C. S., Knighton, A. J., Lake, E., Murin, S., Vintch, J. R. E., Wells, P. S., & Moores, L. K. (2021). Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest, 160(6), e545–e608. CHEST指南2021年更新。
