CAJ | 학술논문

目的探讨急诊非创伤急性胸痛患者30 d死亡的危险因素,建立非创伤急性胸痛危险性评估方法.方法回顾性分析2008 - 2010年北京安贞医院心内科急诊以胸痛为主诉的532例患者的临床资料,将30 d内死亡患者和存活患者的病史、症状体征及化验检查资料进行对照,确定其30 d死亡的独立预测因素,建立非创伤急性胸痛危险性评估表.死亡组与存活组间计量资料的比较采用独立样本t检验,计数资料的比较采用x2检验.危险因素分析用多因素logistic回归分析.结果入选的急诊胸痛患者年龄为(55.7±12.7)岁,其中45例在30 d内死亡,病死率为8.4％.高血压病史(OR:4.28；95％CI:1.59～11.55)、胸痛持续时间延长(OR:1.1；95％ CI:1.05～1.15)、呼吸困难(OR:6.61；95％CI:2.40～18.10)、心率增快(OR:1.02；95％CI:1.00 ～1.04)、白细胞(OR:1.18;95％CI:1.06～1.31)、D二聚体增高(OR:1.002；95％CI:1.001 ～1.002)是患者30 d死亡的独立预测因素,而用药物可缓解的胸痛(OR:0.15；95％ CI:0.04 ～0.65),SaO2(OR:0.89;95％ CI:0.83～0.98),HCT增高(OR:0.92;95％CI:0.86～0.99)可降低30 d的死亡风险.死亡组和存活组相比,非创伤急性胸痛危险性评分较高(P＜0.01).不同评分区间患者病死率差异具有统计学意义(P＜0.01).结论非创伤急性胸痛危险性评分可以快速、有效地判断急诊心内科胸痛患者的预后,评价其30 d的死亡风险.
목적 탐토급진비창상급성흉통환자30 d사망적위험인소,건립비창상급성흉통위험성평고방법.방법 회고성분석2008 - 2010년북경안정의원심내과급진이흉통위주소적532례환자적림상자료,장30 d내사망환자화존활환자적병사、증상체정급화험검사자료진행대조,학정기30 d사망적독립예측인소,건립비창상급성흉통위험성평고표.사망조여존활조간계량자료적비교채용독립양본t검험,계수자료적비교채용x2검험.위험인소분석용다인소logistic회귀분석.결과 입선적급진흉통환자년령위(55.7±12.7)세,기중45례재30 d내사망,병사솔위8.4％.고혈압병사(OR:4.28；95％CI:1.59～11.55)、흉통지속시간연장(OR:1.1；95％ CI:1.05～1.15)、호흡곤난(OR:6.61；95％CI:2.40～18.10)、심솔증쾌(OR:1.02；95％CI:1.00 ～1.04)、백세포(OR:1.18;95％CI:1.06～1.31)、D이취체증고(OR:1.002；95％CI:1.001 ～1.002)시환자30 d사망적독립예측인소,이용약물가완해적흉통(OR:0.15；95％ CI:0.04 ～0.65),SaO2(OR:0.89;95％ CI:0.83～0.98),HCT증고(OR:0.92;95％CI:0.86～0.99)가강저30 d적사망풍험.사망조화존활조상비,비창상급성흉통위험성평분교고(P＜0.01).불동평분구간환자병사솔차이구유통계학의의(P＜0.01).결론 비창상급성흉통위험성평분가이쾌속、유효지판단급진심내과흉통환자적예후,평개기30 d적사망풍험.
Objective To investigate the independent risk factors of 30-day mortality of nontraumatic acute chest pain in emergency department so as to get non - traumatic acute chest pain risk score,Methods The clinical data of 532 patients with non - traumatic acute chest pain were reviewed.The independent risk factors of 30 - day mortality were identified after analysis of medical history,symptom and sign,laboratory findings by uuivariate analysis and logistic regression.Non- traumatic acute chest pain risk score was made as per the odds ratios of these risk factors. Results The average age of the patients was (55.7 + 12.7 ) years,and 45 patients ( 8.4％ ) died after 30 days.In patients with non - traumatic acute chest pain,history of hypertension (OR:4.28; 95％ CI:1.59-11.55 ),prolonged chest pain (OR:1.1; 95％ CI:1.05-1.15),dyspnea (OR:6.61; 95％CI:2.40-18.10) and tachycardia (OR:1.02; 95％CI:1.00-1.04),high leucocyte count (OR:1.18; 95％CI:1.06-1.31) and D - Dimer ( OR:1.002; 95％ CI:1.001-1.002 ) predicted 30 - day mortality independently,whereas chest pain relieved by medicine (OR:0. 15; 95％ CI:0.04-0.65),high blood oxygen saturation (SaO2) (OR:0.89; 95％CI:0.83-0.98) and normal hematocrit (OR:0.92; 95％CI:0.86-0.99) were good markers to predict optimistic prognosis.Non - traumatic acute chest pain risk score was higher in 30 - day dead group than those in survival group significantly ( P ＜ 0.01 ),and mortality was significantly different between groups with various risk stratification (P ＜ 0. 01 ).Conclusions Clinical physician can predict 30 - day mortality and evaluate prognosis in patients with acute chest pain by using non - traumatic acute chest pain risk score quickly and effectively.