PESI指数在确定肺栓塞最佳治疗策略方面的局限性:来自俄罗斯SIRENA登记处的数据

E. Shmidt, S. Berns, I. Zhidkova, O. A. Nagirnyak, A. G. Neeshpapa, O. Barbarash, D. Duplyakov, A. D. Erlikh
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引用次数: 0

摘要

目的:探讨俄罗斯医院临床实践中不同死亡风险的住院期肺栓塞患者的处理方法。设计:注册、多中心、前瞻性观察研究。材料和方法。该研究纳入571例患者(SIRENA注册数据库),根据肺栓塞严重程度指数(PESI)计算所有患者的死亡风险。对低危(PESI I + II级)、中危(PESI III级)和高危(PESI IV + V级)三组患者进行比较分析。结果。在接受溶栓治疗(TLT)的PESI低风险和高风险患者中,死亡率低于未接受溶栓治疗的患者:分别为2 vs 5.9%, 13 vs 30% (p = 0.01)。在接受TLT的中危患者组中,所有患者存活,未接受TLT的患者中,25.8%的患者死亡(p = 0.033)。在低风险的PESI患者中,最常见的溶栓原因是肺动脉主干大量血栓形成(3.9%),首次诊断为急性冠状动脉综合征伴ST段抬高(0.8%),抗凝治疗背景下持续出现呼吸衰竭迹象(5.5%)。根据PESI,在中等风险中,最常见的溶栓原因是存在呼吸衰竭伴低血压(6.2%)和肺动脉大量血栓形成(2.7%)。结论。在PESI指数为中高危的患者中,已证实全身TLT在降低院内死亡风险方面有显著疗效。PESI为中低危的患者需要对是否存在合并症和危险因素、其他仪器和实验室参数、加重因素(中枢性大面积肺血栓合并呼吸衰竭)进行更深入的分析,然后考虑TLT的可能性和可行性。关键词:肺栓塞严重程度指数,肺栓塞,SIRENA登记,溶栓。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Limitations of the PESI Index in Determining the Optimal Treatment Tactics for Pulmonary Embolism: Data from the Russian SIRENA Registry
Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.
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