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

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

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.