慢性血栓栓塞性肺动脉高压诊断与治疗指南(2024版)  

Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension(2024 edition)

作　　者：中华医学会呼吸病学分会肺栓塞与肺血管病学组 中国医师协会呼吸医师分会肺栓塞与肺血管病工作组 全国肺栓塞与肺血管病防治协作组 全国肺动脉高压标准化体系建设项目专家组 谢万木 熊长明 翟振国 王辰[5] 陈耀龙[6] 杨媛华[7] 胡成平[8] Pulmonary Embolism&Pulmonary Vascular Diseases Group of the Chinese Thoracic Society;Pulmonary Embolism&Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians;National Cooperation Group on Prevention&Treatment of Pulmonary Embolism&Pulmonary Vascular Disease;National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension;Xie Wanmu;Xiong Changming;Zhai Zhenguo;Wang Chen(不详;National Center for Respiratory Medicine,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Center for Integrative Medicine,Department of Integrative Pulmonary Diseases,China-Japan Friendship Hospital,Beijing 100029,China;Center of Respiratory and PulmonaryVascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, Beijing 100037, China;National Center forRespiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-JapanFriendship Hospital, Beijing 100029, China;Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]不详 [2]国家呼吸医学中心,国家呼吸系统疾病临床医学研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,国家中西医结合医学中心,中日友好医院中西医结合肺病科,北京100029 [3]中国医学科学院阜外医院呼吸与肺血管病诊治中心,北京100037 [4]国家呼吸医学中心,国家呼吸系统疾病临床医学研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [5]中国医学科学院北京协和医学院,北京100730 [6]兰州大学基础医学院循证医学研究所 [7]首都医科大学附属北京朝阳医院呼吸与危重症医学科 [8]中南大学湘雅医院呼吸与危重症医学科

出　　处：《中华医学杂志》2024年第24期2200-2221,共22页National Medical Journal of China

基　　金：国家重点研发计划(2023YFC2507200);中国医学科学院医学与健康科技创新工程(2021-I2M-1-049);中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-0203);国家自然科学基金(82241029)

摘　　要：慢性血栓栓塞性肺动脉高压(CTEPH)属于第四大类肺动脉高压(PH),以肺动脉管腔内慢性血栓阻塞与继发肺血管重塑为主要病理特征,继而引起肺动脉管腔狭窄和(或)闭塞,肺血管阻力进行性升高,最终可导致右心衰竭甚至死亡。近年来CTEPH领域诊断及治疗进展迅速,日益增多的患者得到了及时、正确的诊断与病情评估。尽管如此,在CTEPH规范化诊治技术推广、CTEPH中心建设等方面还需进一步加强。为了更好指导我国的临床实践,经过多学科专家研讨和德尔菲专家论证,中华医学会呼吸病学分会肺栓塞与肺血管病学组、中国医师协会呼吸医师分会肺栓塞与肺血管病工作组、全国肺栓塞与肺血管病防治协作组及全国肺动脉高压标准化体系建设项目专家组联合多学科专家制订了《慢性血栓栓塞性肺动脉高压诊断与治疗指南(2024)》。本指南系统评价了国内外CTEPH相关循证医学研究资料,提出符合我国临床实践的推荐意见,主要内容包括:定义、流行病学、发病机制、诊断与评估、治疗与管理,以期进一步规范我国CTEPH的临床诊疗工作。Chronic thromboembolic pulmonary hypertension(CTEPH)is classified as group 4 pulmonary hypertension,characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction,progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure,ultimately leading to right heart failure and even death.Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field.More and more patients with CTEPH have been accurately diagnosed and assessed in time.Nevertheless,there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center.To better guide clinical practice in our country,Pulmonary Embolism&Pulmonary Vascular Diseases Group of the Chinese Thoracic Society,Pulmonary Embolism&Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians,National Cooperation Group on Prevention&Treatment of Pulmonary Embolism&Pulmonary Vascular Disease,National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension,convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the"Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension(2024 edition)".These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country.The key areas covered include definitions,epidemiology,pathogenesis,diagnosis and assessment,treatment,and management,with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.

关 键 词：肺栓塞 肺动脉高压 慢性血栓栓塞性肺动脉高压 

分 类 号：R544.1[医药卫生—心血管疾病]