Diagnosticul diferenţial al trombozelor pulmonare/TEAP în unitatea de terapie intensivă

Abstract

Introducere. În literatură există numeroase surse ştiinţifice despre TEAP (tromboembolia arterei pulmonare), însă date clinice sau paraclinice referitoare la diagnosticul diferenţial clinic dintre TEAP şi TAP (tromboza arterei pulmonare) lipsesc; există doar date patomorfologice (postmortem) de diferenţiere a acestora. Scopul lucrării: stabilirea criteriilor clinice sau paraclinice de diagnostic diferenţial clinic dintre TEAP şi TAP pentru crearea algoritmului optim de terapie intensivă al trombozelor pulmonare/ tromboemboliei arterei pulmonare. Material şi metode: În studiu au fost incluşi 150 de pacienţi chirurgicali, internaţi cu suspecţie de TEAP, ce a survenit la bolnavii care au fost supuşi intervenţiilor chirurgicale. Diagnosticul de tromboză pulmonară (TP) l-am suspectat la 13 pacienţi. În studiu au fost incluşi pacienţi cu vârsta cuprinsă între 28-73 ani. Diagnosticul a fost stabilit pe baza datelor clinice, de laborator şi explorări paraclinice. Rezultate: La prima etapă de diagnostic au fost studiate semnele clinice de debut şi evoluţie a acestor sindroame critice. Este cunoscut că TP îşi are geneza de origine locală (pulmonară), iar TEAP este un sindrom pulmonar declanşat de cauze extrapulmonare. Semnele clinice şi anamneza au fost analizate după stabilirea diagnosticului de TEAP/TP în ansamblu; terapia intensivă şi măsurile de resuscitare au fost iniţiate la depistarea sindromului respectiv. Concluzii: orice dispnee, care nu are explicaţie la radiografia pulmonară, trebuie luată în consideraţie, îndeosebi la pacienţii cu prezenţa a cel puţin 2 factori de risc, ca fiind suspecţie de TP sau TEAP.

Introduction. There are a variety of scientific sources about thromboembolism of pulmonary artery in the specialized literature, but clinical and laboratory data on differential clinical diagnosis between thromboembolism of pulmonary artery and pulmonary artery thrombosis are missing, there are only pathomorphological data (postmortem) to differentiate them. Work objective: to establish clinical and laboratory criteria of differential clinical diagnosis between thromboembolism of pulmonary artery and pulmonary artery thrombosis, in order to create optimal intensive care algorithm of pulmonary thrombosis/thromboembolism of pulmonary artery. Material and methods: 150 surgical patients hospitalized with thromboembolism of pulmonary artery suspicion, who have undergone surgery, were included in the study. We suspected pulmonary thrombosis in 13 patients. Patients aged between 28-73 years were included in the study. The diagnosis was established based on clinical and laboratory data and paraclinical explorations. Results: During the first diagnosis stage, clinical signs of onset and development of these critical syndromes were studied. We know that pulmonary thrombosis has local genesis (pulmonary) and thromboembolism of pulmonary artery is a pulmonary syndrome triggered by extra pulmonary causes. Clinical signs and anamnesis were analyzed after diagnosis establishment of thromboembolism of pulmonary artery/pulmonary thrombosis overall, intensive therapy and resuscitation measures were initiated when this syndrome was detected. Conclusions: Any dyspnea which is not explained by the chest x-ray should be taken into consideration, especially in patients with the presence of at least 2 risk factors, such as suspected pulmonary thrombosis or thromboembolism of pulmonary artery.