Usefulness of noninvasive diagnostic tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph.
Usefulness of noninvasive diagnostic tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph.
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无创诊断工具在胸片正常患者急性肺栓塞诊断中的作用。
DOI：
10.1016/0002-9149(91)90875-l
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Weg,JG
中科院分区：
文献类型：
--
作者：
Stein,PD;Alavi,A;Gottschalk,A;Hales,CA;Saltzman,HA;Vreim,CE;Weg,JG
研究了床旁检查和无创检查在胸片正常患者急性肺栓塞（PE）诊断中的价值。 260 名急性肺栓塞患者中，有 20 名（8%）胸片显示正常；642 名疑似急性肺栓塞患者中，有 113 名（18%）胸片显示正常，诊断被排除。在胸片正常的呼吸困难患者中，动脉血氧分压≤70 mm Hg在PE患者中更常见（17.53%中的9例），而在排除PE的患者中（93例中有18例，19%；p < 0.01）。然而，血气、体征和症状的组合并不能严格诊断。胸片正常的患者中，高概率通气/灌注扫描显示 9 名患者中只有 6 名 (67%) 存在肺栓塞。在进行低概率通气/灌注扫描的患者中，47 名患者中有 8 名 (17%) 患有肺栓塞。这项研究表明，胸片正常的患者出现呼吸困难和缺氧的情况对于诊断 PE 是有用的。尽管直觉表明通气/灌注扫描对于胸片正常的患者会产生更好的结果，但通过通气/灌注扫描诊断肺栓塞的能力并没有增强，除非进行中等概率扫描的患者百分比有所减少。
The value of bedside examination and noninvasive tests in the diagnosis of acute pulmonary embolism (PE) among patients with a normal chest radiograph was investigated. Normal chest radiographs were present in 20 of 260 patients (8%) with acute PE and in 113 of 642 (18%) with suspected acute PE, in whom the diagnosis was excluded. A partial pressure of oxygen in arterial blood ≤70 mm Hg in a dyspneic patient with a normal chest radiograph was more often seen among patients with PE (9 of 17,53%) than among patients in whom PE was excluded (18 of 93, 19%; p < 0.01). However, no combinations of blood gases, signs and symptoms were strictly diagnostic. High probability ventilation/perfusion scans among patients with a normal chest radiograph were indicative of PE in only 6 of 9 patients (67%). Among patients with low-probability ventilation/perfusion scans, 8 of 47 (17%) had PE. This study showed that the combination of dyspnea and hypoxia in a patient with a normal chest radiograph is a useful due to the diagnosis of PE. Although intuition suggested that ventilation/perfusion scans would yield better results in patients with a normal chest radiograph, the ability to diagnose PE by ventilation/perfusion scans in this subset of patients was not enhanced, except by a reduction of the percentage of patients with intermediate probability scans.