急诊心源性胸痛患者影响因素的量化分析与分诊判断

目的量化分析心源性胸痛患者的影响因素,为正确分诊提供参考。方法将1514例急性非创伤性胸痛患者,按最终诊断分为心源性胸痛组(476例)和非心源性胸痛组(1038例),对两组一般资料、相关疾病、MEWS评分、疼痛评分,血氧饱和度(SpO2)等指标进行单因素分析、Logistic回归及ROC曲线分析。结果两组性别、年龄、民族、高血压、糖尿病、冠心病、MEWS评分、疼痛评分及SpO2值比较,差异有统计学意义(P<0.05,P<0.01);Logistic回归分析显示上述9项中除民族、糖尿病外,另7项是心源性胸痛的危险因素(OR=1.015~1.810,P<0.05,P<0.01);ROC曲线诊断效能分析显示,年龄48.50岁、MEWS评分2.50分、疼痛评分2.50分、SpO20.88为心源性胸痛危险因素的截点值。结论对胸痛急诊患者,应结合年龄、MEWS评分、疼痛评分、SpO2综合判断是否存在心源性胸痛风险,避免漏诊。

Predictors of cardiogenic pain in emergency patients and discrimination during triage

Objective To identify predictors of cardiogenic pain and to provide reference for triage. Methods A total of 1 514 patients with acute non-traumatic chest pain were recruited: 476 with cardiogenic pain and 1 038 with non-cardiogenic pain. Sociodemographic data, related diseases, MEWS score, pain score and SpO2 value were collected and analyzed using univariate analysis, Logistic regression and ROC curve analysis. Results There were significant differences between the two groups in gender, age, nationality, presence of hypertension/diabetes/coronary heart disease, MEWS score, pain score, and SpO2 value( P <0.05, P < 0.01 ). Logistic regression analysis showed that except nationality and presence of diabetes, the above 7 indicators were risk factors of cardiogenic pain ( OR =1.015-1.810, P <0.05, P <0.01). The ROC curve indicated the cutoff values of age, MEWS score, pain and SpO2 to predict cardiogenic pain were 48.50, 2.50, 2.50, and 0.88, respectively. Conclusion Nursing staff should assess patients with acute chest pain by considering their age, MEWS score, pain score and SpO2 value, thus to identify whether they have a risk of cardiogenic pain and to avoid the probability of missed diagnosis.