产后疑似急性肺栓塞的诊断管理
该研究基于个体患者数据荟萃分析，分析201例产后疑似肺栓塞患者，肺栓塞发生率为6.0%（95%CI 2.9%-12.3%）。29%患者D-二聚体阴性且无一确诊肺栓塞，提示含D-二聚体的诊断流程可用于产后评估。
要点
- 产后疑似肺栓塞患者肺栓塞发生率为6.0%。
- 29%产后疑似肺栓塞患者D-二聚体阴性，均未确诊肺栓塞。
- 含D-二聚体的诊断算法可考虑用于产后肺栓塞评估。
核心结论
- 产后疑似肺栓塞队列肺栓塞发生率为6.0%，提示需建立循证诊断路径。
- 29%患者D-二聚体阴性且无一确诊肺栓塞，含D-二聚体的诊断算法可用于产后评估。
研究设计与样本
- 基于已发表个体患者数据荟萃分析，纳入6项研究的201例产后疑似肺栓塞患者。
主要发现
- 201例产后疑似肺栓塞患者中肺栓塞发生率为6.0%（95%CI 2.9%-12.3%）。
- 29%（29/100，95%CI 21%-39%）产后患者D-二聚体阴性，无论采用何种临床决策规则，阴性者均未确诊肺栓塞。
- 修订版日内瓦评分和PERC临床决策规则表现与既往发表数据相似。
关键数值与推荐
- 产后疑似肺栓塞患者肺栓塞发生率6.0%（95%CI 2.9%-12.3%）。
- D-二聚体阴性比例为29%（29/100，95%CI 21%-39%），阴性者均未确诊肺栓塞。
临床怎么用
- 产后疑似肺栓塞评估可考虑采用含D-二聚体检测的诊断算法。
- 修订版日内瓦评分和PERC可结合D-二聚体与影像学用于产后评估。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
J Thromb Haemost. 2026 Aug;24(8):2992-3001. doi: 10.1016/j.jtha.2026.05.010. Epub 2026 May 19. ABSTRACT BACKGROUND: Pregnancy and the postpartum period increase the risk of venous thromboembolism including pulmonary embolism (PE), which is an important cause of maternal morbidity and mortality. While diagnostic strategies for suspected PE in pregnancy have evolved, postpartum patients remain underrepresented in research. OBJECTIVES: This study evaluated diagnostic strategies and the incidence of PE among postpartum patients presenting to an acute care setting with suspected PE, using data from a previously published individual patient data meta-analysis. METHODS: We analyzed 201 postpartum patients from 6 studies included in the individual patient data meta-analysis. Primary outcomes were PE incidence and a description of the diagnostic tests used. Secondary outcomes included the performance of retrospectively calculated clinical decision rules (CDRs) including the revised Geneva score, pregnancy-adapted Geneva (PAG) score, and pulmonary embolism rule-out criteria (PERC), in combination with D-dimer testing and imaging. RESULTS: Among 201 postpartum patients with suspected PE, the incidence was 6.0% (95% CI, 2.9%-12.3%). The revised Geneva and PERC CDRs performed similarly to previously published data. Notably, 29% (29/100, 95% CI, 21%-39%) of postpartum patients had a negative D-dimer result, and none of those with a negative result were diagnosed with PE, regardless of the CDR used. CONCLUSION: The observed PE incidence of 6.0% in this postpartum cohort underscores the need for evidence-based diagnostic pathways for physicians. Given that 29% of patients had a negative D-dimer and none were diagnosed with PE, diagnostic algorithms incorporating D-dimer testing could be applied in postpartum evaluations. PMID: 42162739 | DOI: 10.1016/j.jtha.2026.05.010
引用
- PubMed 高证据 · 肺栓塞：Diagnostic management of suspected acute pulmonary embolism in the postpartum period
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。