3种量表在心内科病房肺血栓栓塞症诊断的临床预测价值

目的:探讨目前临床较公认的3种临床评估量表在心内科肺血栓栓塞症(PTE)患者人群中的预测价值。方法:回顾性地收集以各种主诉收入我院心内科病房,并在住院期间经螺旋CT肺动脉造影(CTPA)明确诊断PTE的患者40例,对急性肺栓塞的各危险因素和临床特点进行分析,采用Wells量表、Geneva量表和修正的Geneva量表进行临床PTE的可能性评估。结果:Wells量表显示PTE中、高度可能性患者占77.5%,低度可能性者占22.5%;而修正的Geneva量表结果中、低可能性患者约各占50%,高度可能性者为0;Geneva量表结果介于中间。除量表中指标外,25%患者合并有心肺疾病,有晕厥者9例(22.5%),D-二聚体升高(70%)、心电图SⅠQⅢTⅢ(50%)、右束支传导阻滞(35%)等阳性率亦较高。结论:由于PTE临床表现的非特异性与心血管疾病的相似性,对于以不明原因呼吸困难和/或胸痛收入心内科病房的患者,应警惕PTE可能。3种临床评估量表可以作为临床PTE的基本筛查方法,对有中、高度可能性的患者应进一步行CTPA或有创检查明确;对低度可能性者不能轻易排除PTE,建议进一步行相关化验检查,评估行CTPA或有创检查确诊PTE的必要性。对不具备CTPA等检查的基层医院,3种量表在PTE诊断中的临床预测价值可能更大。

The clinical value of three pre-probability scores in prediction of pulmonary embolism admitted to the department of cardiology

Objective：To evaluate the clinical value usage of the three pre-probability scores in prediction of pulmonary embolism（PE） scores in patients admitted to the department of cardiology.Methods：From Feb.2005 to May 2009,40 patients consecutively admitted to the cardiology ward and confirmed with PE by CT pulmonary angiography（CTPA） were entered.All patients＇clinical symptoms,signs,and relevant laboratory tests including arterial blood gas,D-dimer,chest X-ray,ECG and echocardiography were collected,Wells score,Geneva score and revised Geneva score were used to evaluate the probability of PE in these patients.Results：According to Wells score,about 77.5% patients had intermediate or high probability of PE,and 22.5% patients with low probability,as for revised Geneva score,about half to half patients had intermediate and low probability of PE,and no patients had high probability of PE.Among all patients the variables listed in the three scores,about 27.5% patients had no risk factors listed on the scores and more than 1 /4 patients had cardiovascular or pulmonary diseases;only one patient（2.5%） had heamoptysis and 5（12.5%） with symptom and signs of deep vein thrombosis,while 9 patients（22.5%） with syncope;age was the main risk factors in this group patients;palpitation/increased heart rate,one-side edema of lower limb were the main manifestations of PE;about 27.5% patients without obvious risk factors.In addition,positive results of arterial blood gas analysis（37 patients,92.5%） and chest X-ray（4 patients,10%） significantly increased the probability of PE.Besides these variables,D-dimer（elevated in 70% patients） and ECG findings（SⅠQⅢTⅢ in 50% and CRBBB in 35% patients） also showed high positive results in this group patients.Conclusion：Because of the non-specificity and the similarity of clinical manifestations to cardiovascular diseases,many PE patients are admitted to department of cardiology.When the symptoms can not be completely explained with cardiac diseases,PE should be highly suspected.The commonly used pre-probability scores can be used as basic method in screening PE.For patients with high and intermediate probability,CTPA or interventional pulmonary angiography is strongly recommended;for patients with low probability,especially with symptoms of syncope,PE can not simply be excluded,further exams such as blood gas analysis,D-dimer,chest X-ray and ECG are recommended in order to estimate the necessity of further CT pulmonary angiography or interventional pulmonary angiography.The clinic value of three Pre-probability scores in predication of PE in basic-level hospital in the absence of CTPA examination may be greater.