急性主动脉夹层早期诊断的评分模式初探

目的 探讨急性主动脉夹层(AD)患者的临床表现、实验室检查、影像学资料的特征,寻找能早期、准确诊断AD较简便的评分模式.方法 对近3年来我院急诊科收治的182例急性AD患者的临床表现、实验室检查、影像学资料进行分析,并与同期收治的184例胸背痛患者进行对照,探讨AD早期诊断的评分模式.结果 根据logistic回归方程及临床实践建立早期诊断AD的评分模式中,以5分为评分标准,则预测AD的敏感度为96.7%,特异度为81.0%.结论 通过建立以突发的剧烈疼痛、血压明显升高、两侧的血压和(或)脉搏不一致、胸片为主动脉影和(或)纵隔影增宽、D-二聚体明显升高为中心的评分模式能显著提高急性AD急诊诊断水平.

Analysis on an early diagnosis grading model for acute aortic dissection

Objective To investigate the value of an early diagnosis grading model derived from the clinical manifestation, laboratory and imaging data for the diagnosis of aortic dissection ( AD). Methods An early diagnosis grading model was established based on the clinical manifestation, laboratory and imaging data from 182 AD patients who admitted to our department during the last 3 years, 184 patients with chest and back pain served as controls. Results The sensitivity and specificity of diagnosing AD with the score of 5 is 96.7% and 81.0% , respectively. Conclusion The emergency diagnose of AD could be improved based on the established early grading model based on the stabbing and severe pain, rapid blood pressure increase, asymmetry of the blood pressure and/or the pulse, widened aortic knob, mediastinum or descending aorta on X-ray, and significantly increased D-dimmer level.