急性肺动脉栓塞的两种临床预测评分方法的比较研究

Comparison study of two clinical scores of Wells and modified Geneva score for acute pulmonary embolism

目的回顾分析急性肺动脉栓塞（aeute pulmonary embolism，APE）患者确诊检查前的临床资料，探讨肺栓塞的两种临床预测评分方法在诊断中的应用价值。方法对我院急诊科近8年来130例APE患者的临床资料进行回顾分析，用Wells积分法和改良Geneva积分法对APE患者进行预测评分，并对评分进行分析和比较。结果①用Wells积分法对APE患者进行评分，其中低度可能性2．3％（3／130），中度可能性76．9％（100／130），高度可能性20．8％（27／130）。②用改良Geneva积分法进行评分，其中低度可能性22．3％（29／130），中度可能性73．8％（96／130），高度可能性3．9％（5／130）。③用Wells积分法和改良Geneva积分法进行评分，两种方法分值大部分都集中在中度、高度可能性分值区域，比率分别为97．7％、77．7％，两者比较差异有统计学意义（P〈0．01）。结论临床上对中、高度可能性的可疑APE患者应积极进行确诊检查；Wells积分法比改良Geneva积分法更能提高临床医师对APE的警惕性，减少漏诊率。

Objective To analyze the clinical data before performing diagnostic tests in order to investigate the value of two clinical scores of Wells and modified Geneva score in the diagnosis of acute pulmonary embolism（APE）. Methods 130 APE consecutive patients treated in the Third Hospital of Peking University during recent 8 years were analyzed retrospectively. All the patients were assessed by Wells score and modified Geneva score, then the scores of two methods were analyzed and compared. Results ①According to Wells score, 2.3 % of patients had low clinical probability, 76.9% had moderate clinical probability, and 20.8% had high clinical probability.②according to modified Geneva score, the patient percentage of low, moderate and high clinical probability were 22.3% , 73.8% and 3.9% respectively. ③most patients had moderate or high clinical probability assessed by Wells and modified Geneva score. The percent of moderate and high clinical probability were 97.7% and 77.7% respectively, which were significantly different （ P 〈 0.01 ）. Conclusion The patients of moderate or high clinical probability were more than the patients of low probability. In the patients with moderate or high clinical probability, diagnostic tests should be performed actively. Compared with modified Geneva score, Wells score could improve physician＇s vigilance of acute pulmonary embolism better and decrease the rate of missed diagnosis.