动脉血二氧化碳分压联合Wells评分有助于预测急性肺栓塞

Arterial partial pressure of carbon dioxide combined with Wells score helps predict acute pulmonary embolism

目的探索动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))联合Wells评分预测急性肺栓塞(acute pulmonary embolism,APE)的临床价值。方法回顾性收集2016年1月1日至2021年8月31日期间就诊于首都医科大学附属北京朝阳医院急诊科疑似APE的患者,以计算机断层扫描肺血管造影术(computed tomography pulmonary angiography,CTPA)结果阳性者为肺栓塞(pulmonary embolism,PE)组,阴性者为非肺栓塞(non-pulmonary embolism,Non-PE)组,对两组人口统计学特征、症状、生命体征、基础疾病、静脉血栓危险因素、动脉血气分析、Wells评分等进行统计学分析比较,并对PaCO_(2)联合Wells评分预测APE的临床效度进行评价。结果共筛选疑似APE患者1869例,最终入选1492例,PE组537例,Non-PE组955例。胸痛、呼吸困难、单侧下肢水肿、肺栓塞或静脉血栓史、3月内手术或制动史、3月内骨折史、活动期恶性肿瘤、Wells评分升高及PaCO_(2)降低在PE组出现的频率显著高于Non-PE组(均P<0.05)。Wells评分的ROC曲线下面积(AUC)为0.784(95%CI:0.758~0.810),预测APE的敏感度为61.64%,特异度为88.48%;PaCO_(2)降低的AUC为0.679(95%CI:0.651~0.707),预测APE的敏感度为79.89%,特异度为55.92%;PaCO_(2)降低联合Wells评分的AUC为0.837(95%CI:0.816~0.858),预测APE的敏感度为74.12%,特异度为77.07%。PaCO_(2)降低联合Wells评分的AUC显著大于Wells评分的AUC(P<0.001)和PaCO_(2)降低的AUC(P<0.001)。结论PaCO_(2)降低联合Wells评分预测APE的效能优于单独应用其中一种,是对APE患者筛查的有益补充,同时也将对急诊减少CTPA的盲目使用起到一定帮助。

Objective To explore the clinical value of arterial partial pressure of carbon dioxide(PaCO_(2))combined with Wells score in predicting acute pulmonary embolism(PE).Methods Patients with suspected acute PE admitted to Emergency Department of Beijing Chaoyang Hospital,Capital Medical University from January 1,2016 to August 31,2021 were screened.Patients with positive computed tomography pulmonary angiography(CTPA)results were classified as the PE group,and those with negative CTPA results were classified as the non-PE group.Demographic characteristics,symptoms,vital signs,underlying diseases,risk factors for venous thrombosis,arterial blood gas analysis and Wells scores were statistically analyzed and compared between the two groups,and the clinical efficacy of PaCO_(2) combined with Wells score in predicting acute PE was evaluated.Results A total of 1869 patients with suspected acute PE were screened,and 1492 patients were finally selected.There were 537 cases in the PE group and 955 cases in the non-PE group.The frequency of chest pain,dyspnea,unilateral lower limb edema,history of PE or deep venous thrombosis,history of surgery or immobilization within 3 months,history of fracture within 3 months,active malignant tumor,elevated Wells score and reduced PaCO_(2) in the PE group was significantly higher than that in the non-PE group(all P<0.05).The area under receiver operating characteristic(ROC)curve(AUC)of Wells score was 0.784(95%CI:0.758-0.810),and the sensitivity and specificity of predicting acute pulmonary embolism were 61.64% and 88.48%,respectively.The AUC of reduced PaCO_(2) was 0.679(95%CI:0.651-0.707),and the sensitivity and specificity of predicting acute pulmonary embolism were 79.89% and 55.92%,respectively.The AUC of reduced PaCO2 combined with Wells score was 0.837(95%CI:0.816-0.858),and the sensitivity and specificity of predicting acute pulmonary embolism were 74.12% and 77.07%,respectively.The AUC of reduced PaCO2 combined with Wells score was significantly greater than the AUC of Wells score(P<0.001)and the AUC of reduced PaCO_(2)(P<0.001).Conclusions The efficacy of PaCO_(2) reduction combined with Wells score in predicting acute PE was superior to that of either of them alone.This was a beneficial supplement to the screening of patients with acute PE,and would also help reduce the abuse of CTPA in the emergency department.