胸痛规范化评估在急性肺栓塞CT血管造影检查中的应用价值

Application of standardized assessment of chest pain in CT angiography of acute pulmonary embolism

目的探讨急性胸痛患者进行胸痛规范化评估后，cT血管造影（CTA）检查对急性肺栓塞（APE）的应用价值。方法回顾性分析梧州市中医医院及梧州市工人医院2014年1月至2016年5月行CTA检查的急性胸痛患者43例的临床资料，进行胸痛规范化评估后，疑似APE的通过肺动脉CTA扫描方式筛查的16例患者作为观察组；未进行胸痛规范化评估的27例患者作为对照组，通过胸部CTA扫描方式排查胸痛病因。比较两组APE的CTA确诊例数，观察组APE筛查量表评分、D-二聚体对确诊APE的作用，分析胸痛规范化评估对APE的应用价值。结果观察组与对照组CTA确诊对比阳性率高，两组差异有统计学意义（χ^2=3．93，P〈0．05）。观察组APE确诊患者APE筛查量表评分、D-二聚体分别为（9．64±4．74）分、（886．73±191．83）μg／L，APE排除患者分别为（2．20±1．64）分、（587．20±35．79）μg／L，两者差异均有统计学意义（t=3．363、3．402，均P〈0．01）。结论急性胸痛患者进行胸痛规范化评估后，优化了CTA检查，提高了APE的确诊率，降低误诊及漏诊率，为临床医生提供了及时、准确的诊断依据，为进一步处置争取到宝贵时机。

Objective To evaluate the clinical value of CT angiography （CTA） in the diagnosis of acute pulmonary embolism （APE） after standardized chest pain assessment in patients with acute chest pain. Methods From January 2014 to May 2016 ,The clinical data of 43 patients with acute chest pain in Wuzhou Hospital of Traditional Chinese Medicine and Wuzhou Worker ＂s Hospital received CTA examination were retrospectively analyzed. After standardized assessment,16 patients with suspected APE through pulmonary artery CTA scan screening were selected as observation group. 27 cases of chest pain who were not received standardized assessment were selected as the control group,the chest CTA scan was used to investigate the causes of chest pain. The number of CTA confirmed by APE in two groups was compared. The effect of APE screening scale score and D - Dimer on the diagnosis of APE in the observation group was analyzed, and the application value of standardized evaluation of chest pain in APE was analyzed. Results The positive rate of CTA in the observation group was higher than that in the control group, and the difference between the two groups was statistically significant（ χ^2 = 3.93 ,P 〈 0.05 ）. The APE screening scale and D - Dimer in the observation group were （9.64± 4.74） points and （886.73 ± 191.83 ） μg/L, respectively, which in the APE excluded patients were （ 2.20±1.64 ） points, （587.20 ± 35.79 ） μg/L, respectively, the differences were statistically significant （ t = 3. 363,3. 402, all P 〈 0.01 ）. Conclusion Patients with acute chest pain and chest pain are standardized after the evaluation, optimization of CTA examination and improve the diagnostic rate of APE, reduce the rate of misdiagnosis and missed diagnosis, provide timely and accurate diagnostic basis for clinicians to gain valuable opportunity for further disposal.