基于倾向性评分评估标准版胸痛中心对急性肺栓塞救治情况的改进作用

To evaluate the improvement effect of chest pain center on the treatment of acute pulmonary embolism based on propensity score

目的探讨基于倾向性评分(PSM)评估标准版胸痛中心对急性肺栓塞救治情况的改进作用。方法回顾性分析2011年9月至2020年9月贵州医科大学附属医院就诊的急性肺栓塞病人。通过倾向性评分,按1∶1最近邻居匹配法进行匹配。以经胸痛中心救治的66例作为观察组,以其各自评分为标准,在未经胸痛中心救治的145例中匹配与之评分最接近的病人,最终经倾向性匹配后66例入组为对照组。结果两组病人倾向性匹配前的年龄(P=0.008)、男性(P=0.032)、低危分层(P=0.041)、下肢深静脉血栓史(P=0.030)、无合并症(P=0.001)及既往抗凝比例(P=0.032)6个因子与对照组相比差异有统计学意义。两组标准均值除卧床(5%)、甲状腺功能亢进(6%)、冠心病(6%)、高血压(6%)、房颤(8%)、肾病(8%)、哮喘(9%)7个因子小于10%外,其余均大于10%。在进行倾向性匹配后两组间的因子差异无统计学意义(P>0.05),两组间的标准均值差均>10%。观察组误诊率(6.06%比25.76%,P=0.002)、漏诊率(3.03%比19.70%,P=0.003)及院内病死率(3.03%比13.64%,P=0.027)均低于对照组,差异有统计学意义;观察组接诊至CTPA报告时间[(70.45±16.42)min比(130.25±17.35)min,P<0.001],确诊至抗凝时间[(21.45±7.66)min比(54.35±8.27)min,P<0.001]及确诊至溶栓时间[(31.23±6.32)min比(63.05±10.13)min,P<0.001]均明显低于对照组,差异有统计学意义;观察组平均住院日[(11.18±1.37)d比(13.12±1.45)d,P<0.001]及平均住院费用[(59420.12±7350.75)元比(74503.25±7903.87)元,P<0.001]均低于对照组,差异有统计学意义。结论胸痛中心的建设降低了急性肺栓塞病人的误诊率、漏诊率及院内病死率,降低了病人的住院成本及住院天数,应该积极大力推行。

Objective To evaluate the improvement effect of chest pain center on the treatment of acute pulmonary embolism based on propensity score.Methods Patients with acute pulmonary embolism in the Affiliated Hospital of Guizhou Medical University from September 2011 to September 2020 were retrospectively analyzed.Through propensity score(PSM),matching was performed according to the 1∶1 nearest neighbor matching method.66 cases treated by chest pain center enrolled as the observation group.According to their own score,145 patients without chest pain center treatment were matched with the patients with the closest score,and 66 cases were finally enrolled as the contrl group after propensity matching.Results The six factors of age(P=0.008),male(P=0.032),low-risk stratification(P=0.041),history of lower extremity deep vein thrombosis(P=0.030),absence of comorbidities(P=0.001)and proportion of previous anticoagulation(P=0.032)before propensity matching were statistically significantly different in both groups compared to the control group.The standard mean differences(SMDs)between the two groups were less than 10%for the seven factors of bedridden(5%),hyperthyroidism(6%),coronary artery disease(6%),hypertension(6%),atrial fibrillation(8%),renal disease(8%),and asthma(9%)and greater than 10%for all other factors.There was no statistical difference between the two groups after propensity matching(P>0.05),and the SMDs between the two groups was>10%.The rates of misdiagnosis(6.06%vs.25.76%,P=0.002),missed diagnosis(3.03%vs.19.70%,P=0.003)and in-hospital mortality(3.03%vs.13.64%,P=0.027)in the observation group were lower than those in the control group,with statistically significant differences;the time from diagnosis to CTPA report[(70.45±16.42)min vs.(130.25±17.35)min,P<0.001],time from diagnosis to anticoagulation[(21.45±7.66)min vs.(54.35±8.27)min,P<0.001]and time from diagnosis to thrombolysis[(31.23±6.32)min vs.(63.05±10.13)min,P<0.001]in the observation group were significantly lower than those in the control group.The mean hospitalization days[(11.18±1.37)d vs.(13.12±1.45)d,P<0.001]and mean hospital charges[(59420.12±7350.75)yuan vs.(74503.25±7903.87)yuan,P<0.001]in the observation group were lower than those in the control group,which were statistically different.Conclusion The construction of the chest pain center reduces the misdiagnosis rate,missed diagnosis rate and hospital mortality of patients with acute pulmonary embolism,reduces the cost of hospitalization and mean hospitalization days,which should be actively implemented.