改良急性主动脉夹层风险评分在急性主动脉夹层早期诊断中的价值

Value of modified AAD risk score in early diagnosis of acute aortic dissection

目的:收集急性主动脉夹层(AAD)患者在高危病史、临床症状、体征、实验室检查、床旁彩超表现的特征,总结归纳能早期床旁诊断AAD的评分方法及预警模式。方法:收集2016-10—2018-10期间于我院急诊科就诊的164例胸背部疼痛患者的病史、临床症状、体征、实验室检查、床旁彩超表现。并与最终确诊为AAD的42例患者对照,进行多因素Logistic回归分析,根据其OR值的大小,对独立危险因素赋予分值,建立评分表。通过评分表预测胸痛患者发生AAD的概率。结果:Logistic回归分析发生AAD的危险因素包括:性别、高危病史、突发剧烈的胸背部疼痛、双侧血压不对称、高血压、D-二聚体升高、床旁彩超相关表现。根据改良的AAD评分,以5分为评价标准预测AAD发生的敏感度为95.4%,特异度为84.9%。改良后的AAD评分受试者工作特征曲线下面积为0.908,结论:改良AAD评分能够在床旁快速准确地预测主动脉夹层的发生。

Objective:To collect the characteristics of patients with acute aortic dissection(AAD)in high-risk medical history,clinical symptoms,physical signs,laboratory examinations and bedside color Doppler ultrasonography,and summarize the scoring methods and early warning modes for early bedside diagnosis of AAD.Method:The medical history,clinical symptoms,physical signs,laboratory examinations and bedside color Doppler ultrasound findings of 164 patients with thoracic and dorsal pain who were treated in the Emergency Department of Yellow River Sanmenxia Hospital from October 2016 to October 2018 were collected.Multivariate logistic regression analysis was performed on 42 patients who were definitely diagnosed with AAD.According to their OR value,independent risk factors were assigned scores and scoring tables were established to predict the probability of AAD in patients with chest pain.Result:Logistic regression analysis showed that the risk factors for AAD included gender,high-risk medical history,sudden and severe chest and back pain,bilateral blood pressure asymmetry,hypertension,elevated D-Dimer,and bedside color Doppler ultrasound-related manifestations.According to the modified AD score,the sensitivity and specificity for predicting the occurrence of AAD were 95.4%and 84.9%respectively with a 5-scores standard.The area under the working curve of ROC subjects was 0.908 on the modified AAD score.Conclusion:Modified AAD score can quickly and accurately predict the occurrence of aortic dissection at bedside.