“胸痛中心”对主动脉夹层患者诊疗及预后的影响

Influence of "chest pain center" on diagnosis,treatment and prognosis of aortic dissection patients

目的:分析胸痛中心(CPC)管理模式对急诊科主动脉夹层(AD)患者诊疗及预后的影响。方法:对比九江市第一人民医院CPC成立前后4年急诊科接诊的AD患者的诊疗时间、误诊漏诊率、院内夹层破裂发生率、院内死亡率及半年内死亡率,并对可能影响AD患者存活出院和半年后存活的相关因素进行Logistic回归分析。结果:入选186例AD患者,其中CPC成立前94例,CPC成立后92例。CPC成立后AD患者从就诊至主动脉血管造影(CTA)出报告的间隔时间、急诊处置时间、误诊率、院内夹层破裂发生率、院内死亡率及出院后半年内死亡率均显著低于CPC成立前(均P <0. 05)。Logistic回归分析显示CPC管理模式是AD患者存活出院(OR=8. 627,P=0. 001)及出院患者半年后存活(OR=3. 137,P=0. 045)的独立预测因子。结论:CPC管理模式可显著缩短AD患者的诊疗时间,降低误诊率,减少院内夹层破裂的发生率,明显改善患者预后,具有显著的经济效益和社会效益。

Objective: To analyze the influence of " chest pain center(CPC) " management mode on diagnosis,treatment and prognosis of aortic dissection(AD) patients from department of emergency(ED). Methods: The time of clinic procedure,the rate of misdiagnosis and the rate of missed diagnosis,the incidence of in-hospital dissection rupture,intrahospital mortality and the death rate within a half year of AD patients from ED during four years before and after CPC being established were compared. Logistic regression analysis was performed to evaluate factors probably influencing survival at discharge and survival within a half year. Result: A total of 186 AD patients were enrolled,of which 94 patients were treated before CPC establishment and 92 patients were treated after CPC establishment. Compared with patients treated before CPC establishment,the interval time between being treated and aortal computerized tomography angiography(CTA) reporting,the time of being treated in ED,the rate of misdiagnosis,the incidence of in-hospital dissection rupture,intra-hospital mortality and the death rate within a half year of patients treated after CPC establishment all decreased significantly(P < 0. 05). Logistic regression analysis showed CPC management mode was an independent predictor of survival at discharge(OR =8. 627,P = 0. 001) and survival within a half year(OR = 3. 137,P = 0. 045). Conclusions: CPC management mode can significantly shorten the clinic procedure time of AD patients,decrease the rate of misdiagnosis and the incidence of in-hospital dissection rupture,improve clearly patients’ prognosis and make huge economic and social benefits.