非创伤急性胸痛危险性评估方法的研究

时间:2022-10-16 12:43:01

非创伤急性胸痛危险性评估方法的研究

中华急诊医学杂志2012年8月第21卷第8期Chin J Emerg Med,August 2012,Vol.21,No.8

P863-868

【摘要】目的 探讨急诊非创伤急性胸痛患者30 d死亡的危险因素,建立非创伤急性胸痛危险性评估方法。方法 回顾性分析2008-2010年北京安贞医院心内科急诊以胸痛为主诉的532例患者的临床资料,将30 d内死亡患者和存活患者的病史、症状体征及化验检查资料进行对照,确定其30 d死亡的独立预测因素,建立非创伤急性胸痛危险性评估表。死亡组与存活组间计量资料的比较采用独立样本t检验,计数资料的比较采用χ2检验。危险因素分析用多因素logistic回归分析。结果 入选的急诊胸痛患者年龄为(55.7±12.7)岁,其中45例在30 d内死亡,病死率为8.4%。高血压病史(OR:4.28; 95%CI:1.59~11.55)、胸痛持续时间延长(OR:1.1; 95%CI: 1.05~1.15)、呼吸困难(OR:6.61; 95%CI: 2.40~18.10)、心率增快(OR:1.02; 95%CI: 1.00~1.04)、白细胞(OR:1.18; 95%CI: 1.06~1.31)、D二聚体增高(OR:1.002; 95%CI: 1.001~1.002)是患者30 d死亡的独立预测因素,而用药物可缓解的胸痛(OR:0.15; 95%CI: 0.04~0.65),SaO2 (OR:0.89; 95%CI: 0.83~0.98),HCT增高(OR:0.92; 95%CI: 0.86~0.99)可降低30 d的死亡风险。死亡组和存活组相比,非创伤急性胸痛危险性评分较高(P<0.01)。不同评分区间患者病死率差异具有统计学意义(P<0.01)。结论 非创伤急性胸痛危险性评分可以快速、有效地判断急诊心内科胸痛患者的预后,评价其30 d的死亡风险。

【关键词】非创伤;胸痛;病死率;危险分层;危险评分

A study of nontraumatic acute chest pain risk stratification in emergency department GAO Yun , LIU Tong, YIN Cheng-qian, SUN Tao, LI Zhi-zhong, ZHANG Jing-mei. Cardiology Department 15th Ward , Bejing Anzhen Hospital Affiliated Capital Medical University, Beijing 100029, China.

Corresponding author: LI Zhi-zhong, Email: .

【Abstract】Objective To investigate the independent risk factors of 30-day mortality of non-traumatic acute chest pain in emergency department so as to get non-traumatic acute chest pain risk score. Methods The clinical data of 532 patients with non-traumatic acute chest pain were reviewed. The independent risk factors of 30-day mortality were identified after analysis of medical history, symptom and sign, laboratory findings by univariate analysis and logistic regression. Non-traumatic acute chest pain risk score was made as per the odds ratios of these risk factors.Results The average age of the patients was (55.7±12.7 ) years, and 45 patients (8.4%) died after 30 days. In patients with non-traumatic acute chest pain, history of hypertension (OR: 4.28; 95%CI:1.59-11.55), prolonged chest pain (OR:1.1; 95% Cl: 1.05-1.15), dyspnea (OR:6.61; 95%CI: 2.40-18.10) and tachycardia (OR:1.02; 95%CI: 1.00-1.04), high leucocyte count (OR:1.18; 95%CI: 1.06-1.31) and D-Dimer (OR:1.002; 95%CI: 1.001-1.002) predicted 30-day mortality independently, whereas chest pain relieved by medicine (OR:0.15; 95%CI: 0.04-0.65), high blood oxygen saturation (SaO2)(OR:0.89; 95%CI: 0.83-0.98) and normal hematocrit (OR:0.92; 95%CI: 0.86-0.99) were good markers to predict optimistic prognosis. Non-traumatic acute chest pain risk score was higher in 30-day dead group than those in survival group significantly(P

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