切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 349 -352. doi: 10.3877/cma.j.issn.1674-0793.2021.05.007

论著

主动脉夹层危险因素监测评分在急性主动脉夹层患者快速分诊中的应用
陈月娥1, 徐丽青1, 魏冬花1, 李元1, 李继红1,()   
  1. 1. 510080 广州,中山大学附属第一医院急诊科
  • 收稿日期:2021-02-27 出版日期:2021-09-28
  • 通信作者: 李继红

Application of the aortic dissection detection risk score in rapid screening in emergency triage of patients with aortic dissection

Yuee Chen1, Liqing Xu1, Donghua Wei1, Yuan Li1, Jihong Li1,()   

  1. 1. Department of Emergency, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2021-02-27 Published:2021-09-28
  • Corresponding author: Jihong Li
引用本文:

陈月娥, 徐丽青, 魏冬花, 李元, 李继红. 主动脉夹层危险因素监测评分在急性主动脉夹层患者快速分诊中的应用[J/OL]. 中华普通外科学文献(电子版), 2021, 15(05): 349-352.

Yuee Chen, Liqing Xu, Donghua Wei, Yuan Li, Jihong Li. Application of the aortic dissection detection risk score in rapid screening in emergency triage of patients with aortic dissection[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(05): 349-352.

目的

探讨主动脉夹层危险因素监测评分(ADD-RS)在急性主动脉夹层(AD)患者快速分诊的应用。

方法

运用ADD-RS表对2018年1月至2019年12月中山大学附属第一医院就诊且主诉为急性胸背部疼痛或腹痛的318例患者进行分诊初筛。主动脉增强CT检查作为AD确诊"金标准",比较ADD-RS初筛结果与主动脉增强CT确诊结果。

结果

通过ADD-RS表初筛患者最终经主动脉增强CT检查,确诊AD患者(AD组)50例,非AD患者(非AD组)268例,比较两组的一般资料及危险因素评分结果,显示AD组患者高血压比例、体质指数、疼痛评分均明显高于非AD组(P<0.05),年龄、糖尿病比例均低于非AD组(P<0.05);AD组的ADD-RS评分明显高于非AD组,差异有统计学意义(P<0.05)。ADD-RS预测AD的ROC曲线下面积为0.852(95% CI:0.796~0.908),敏感度为0.940,特异度为0.373。

结论

ADD-RS适用于快速筛查AD,可作为急性AD急诊分诊的可靠工具。

Objective

To investigate the application of aortic dissection detection risk score (ADD-RS) in rapid triage of acute aortic dissection (AD).

Methods

From January 2018 to December 2019, 318 patients with acute chest and back pain or abdominal pain in the First Affiliated Hospital of Sun Yat-sen University were evaluated with ADD-RS. Aortic enhanced CT examination was the golden standard for the diagnosis of aortic dissection. The preliminary screening results of ADD-RS were compared with the diagnostic results of aortic enhanced CT.

Results

After initial screening by ADD-RS, 50 patients were diagnosed with AD (AD group) and 268 patients were diagnosed with non-AD (non-AD group) by aortic enhanced CT examination. The general clinical information and ADD risk scores of the two groups were compared. The results showed that the hypertension rate, BMI and pain score in AD group were significantly higher than those in non-AD group (P<0.05). AD group were younger and the proportion of diabetes was lower than those in non-AD group (P<0.05). The ADD-RS of AD group was significantly higher than that of non-AD group, and the difference was statistically significant (P<0.05). The maximum area under the ROC curve for AD predicted by ADD-RS was 0.852 (95% CI: 0.796-0.908), and its sensitivity and specificity were 0.940 and 0.373 respectively.

Conclusion

ADD-RS deserves as an early and reliable screening tool for acute AD in emergency triage.

表1 主动脉夹层危险因素评分表
表2 AD组和非AD组临床基线资料比较
表3 AD组和非AD组疼痛评分比较[例(%)]
表4 AD组与非AD组的ADD-RS评分比较[例(%)]
图1 ADD-RS筛查急性主动脉夹层的ROC曲线
[3]
Zhan S, Hong S, Shan-Shan L, et al. Misdiagnosis of aortic dissection: experience of 361 patients[J]. J Clin Hypertens (Greenwich), 2012, 14(4): 256-260.
[4]
Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection[J]. Am J Cardiol, 2007, 99(6): 852-856.
[5]
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine[J]. Catheter Cardiovasc Interv, 2010, 76(2): E43-E86.
[6]
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
[7]
Rogers AM, Hermann LK, Booher AM, et al. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation[J]. Circulation, 2011, 123(20): 2213-2218.
[8]
Ohno-Urabe S, Aoki H, Nishihara M, et al. Role of macrophage socs3 in the pathogenesis of aortic dissection[J]. J Am Heart Assoc, 2018, 7(2): e007389.
[9]
Caesar C, Lyle AN, Joseph G, et al. Cyclic strain and hypertension increase osteopontin expression in the aorta[J]. Cell Mol Bioeng, 2017, 10(2): 144-152.
[10]
石烽, 王志维. 主动脉夹层发病相关危险因素分析[J]. 中华老年心脑血管病杂志, 2020, 22(1): 28-31.
[11]
Luo Y, Huang Z, Liao J, et al. Downregulated GTCPH I/BH4 pathway and decreased function of circulating endothelial progenitor cells and their relationship with endothelial dysfunction in overweight postmenopausal women[J]. Stem Cells Int, 2018, 2018: 4756263.
[12]
高娟,余娟,杨慧敏.急性主动脉综合征患者疼痛相关因素分析[J]. 护理学杂志, 2013, 28(5): 33-34.
[13]
Thompson A, Cooper JA, Fabricius M, et al. An analysis of drug modulation of abdominal aortic aneurysm growth through 25 years of surveillance[J]. J Vasc Surg, 2010, 52(1): 55-61.
[14]
Hsu CY, Su YW, Chen YT, et al. Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm: A nested case-control analysis[J]. Cardiovasc Diabetol, 2016, 15(1): 125.
[15]
Raffort J, Lareyre F, Clément M, et al. Diabetes and aortic aneurysm: current state of the art[J]. Cardiovasc Res, 2018, 114(13): 1702-1713.
[16]
蒋艳妮,杜少兰,朱波,等.胸痛中心急诊绿色通道护理流程对提高主动脉夹层患者治疗效果的作用[J].临床医学研究与实践, 2019, 4(8): 150-151.
[1]
Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002[J]. Circulation2006, 114(24): 2611-2618.
[2]
Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence, risk factors, outcome, and prognosis of ischemic peripheral arterial events: implications for prevention[J]. Circulation, 2015, 132(19): 1805-1815.
[1] 明昊, 肖迎聪, 巨艳, 宋宏萍. 乳腺癌风险预测模型的研究现状[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 287-291.
[2] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[3] 黄鸿初, 黄美容, 温丽红. 血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 285-292.
[4] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[5] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[6] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[7] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[8] 王庭宇, 邵联波, 刘珊, 沈振亚. Stanford A 型主动脉夹层相关基因KIF20A 的共表达网络构建及作用靶点分析[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 303-312.
[9] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[10] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[11] 李晓东, 王汉宇, 马龙, 刘亮, 魏云, 李昂. 小脑后下动脉瘤的显微手术治疗[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 318-320.
[12] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[13] 李文哲, 王毅, 崔建, 郑启航, 王靖彦, 于湘友. 新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 269-276.
[14] 刘志超, 胡风云, 温春丽. 山西省脑卒中危险因素与地域的相关性分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 424-433.
[15] 曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.
阅读次数
全文


摘要