摘要
目的 分析急诊疑诊肺栓塞(pulmonary embolism,PE)患者计算机断层扫描肺血管造影(CTPA)检查指南依从性。方法 本研究为单中心回顾性研究。收集2018年1月1日至2021年12月31日在北京大学第三医院急诊就诊进行CTPA检查患者的临床资料,根据CTPA检查结果分为PE组和非PE组,根据欧州心脏病学会(ESC)指南推荐,计算每位患者PE临床可能性的简化Wells评分(mWS)、改良的Geneva评分(rGS)和YEARs评分,并进行指南依从性分析。结果 共纳入1 062例疑诊PE患者,根据CTPA结果分为PE组341例,非PE组721例,CTPA阳性率32.1%,按照3种评分推荐流程进行CTPA的指南依从率分别为75.8%、79.8%及65.6%,当依从指南推荐时,可将CTPA阳性率分别提高至39.0%(P=0.002)、37.3%(P=0.018)和40.2%(P<0.001)。其中有68例患者尽管各类临床可能性评分分类至少有一种为“低危”或“不可能”,但CTPA仍为阳性结果。结论 依从指南推荐的CTPA检查流程可明显提高PE诊断阳性率,同时,应进一步关注评分阴性PE患者,从而提高诊断准确性。
Objective To analyze the guideline compliance of computed tomographic pulmonaric angiography(CTPA) in the suspected patients of pulmonary embolism(PE) in emergency department.Methods This was a single-center retrospective study.Clinical data of patients who underwent CTPA in the emergency department of Peking University Third Hospital from January 1,2018 to December 31,2021 were collected.According to CTPA results,the patients were divided into PE group and non-PE group.Simplified Wells score(mWS),revised Geneva score(rGS) and YEARs score were calculated for the clinical possibility of PE for each patient according to European Society of Cardiology(ESC) guideline recommendations.The guidelines compliance was analyzed.Results A total of 1 062 suspected PE patients were included,and were divided into PE group(341 cases) and non-PE group(721 cases) according to CTPA results.CTPA positive rate was 32.1%.CTPA compliance rates were 75.8%,79.8% and 65.6% according to the recommendation processes of three scores,respectively.CTPA positive rate was increased to 39.0%(P=0.002),37.3%(P=0.018) and 40.2%(P<0.001),respectively.There were 68 patients with a positive CTPA result despite a low or unlikely clinical likelihood of PE.Conclusions The CTPA examination procedure recommended by the guidelines can significantly improve the positive rate of PE diagnosis.Further attention should be paid to PE patients with negative scores to improve the accuracy of diagnosis.
作者
陈玉娇
李姝
张华
马青变
葛洪霞
Chen Yujiao;Li Shu;Zhang Hua;Ma Qingbian;Ge Hongxia(Emergency Department,Peking University Third Hospital,Beijing 100191,China)
出处
《中国急救医学》
CAS
CSCD
2024年第3期220-225,共6页
Chinese Journal of Critical Care Medicine
