اشتباهات شایع در بخش آی سی یو 12

سلام،

مطلبی که در ادامه مشاهده خواهید کرد به قابلیت تشخیصی آزمایش D-Dimer در آمبولی ریوی اشاره دارد. همانطوری که می دانید این آزمایش فقط می تواند آمبولی ریوی را رد کند.به عبارتی مثبت بودن آن به معنای اثبات آمبولی ریوی نیست...

D-Dimer Levels Can Rule Out But Not Rule in Pulmonary Embolism in Postoperative Patients
Hari Nathan MD
D-dimer is a degradation product of cross-linked fibrin. A normal level of d-dimer is typically less than 500 ng/mL. In a patient with pulmonary embolism (PE), deep venous thrombosis (DVT), or other clot burden, elevated d-dimer levels reflect the body's endogenous fibrinolysis. Inaddition, d-dimer levels may also be raised in myocardial infarction, pneumonia, sepsis, and cancer; during the second and third trimesters of pregnancy; and after surgery. Elevated d-dimer levels may persist up to 3 months after surgery.
When DVT or PE is suspected in a postoperative patient, normal d-dimer levels argue against the diagnosis. The negative predictive value of the test varies from 85% to 99%, depending on the assay used and the pretest probability of PE. Elevated d-dimer levels, while consistent with PE, by no means confirm the diagnosis in postoperative patients. Thrombus in locations other than the pulmonary arterial bed (as in DVT or clot at the site of surgery) can explain d-dimer elevations, as can any of the factors listed previously. Therefore, if the clinical suspicion of PE is low, a normal d-dimer level is helpful in ruling out the diagnosis. When the clinical suspicion of PE is high, further investigation is mandated regardless of the d-dimer level.
Suggested Readings
Goldhaber SZ. Pulmonary embolism. Lancet. 2004;363:1295–1305.
Thompson BT, Hales CA. Clinical manifestations of and diagnostic strategies for acute pulmonary embolism. In: Rose BD, ed. UpToDate. Waltham, MA: UpToDate; 2006.
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