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目的:寻找快速简单急诊预判急性主动脉夹层(AAD)诊断的临床指标,指导急诊医师快速正确选择相关检查,以尽快明确诊断。方法:观察2013-01-2016-12以突发疼痛(胸部疼痛、背部疼痛、突发疼痛、转移性疼痛)为主诉的急诊患者902例。根据疼痛强度评分量表分为轻度组、中度组和重度组;依据临床高危特征分为低危组、中危组和高危组,观察各组AAD诊断率。结果:急诊突发疼痛902例患者中以中、重度疼痛患者居多,共计793例;轻度疼痛组AAD诊断率仅为0.61%,明显低于中、重度疼痛(7.32%、7.58%)组(P<0.05);中、重度组间诊断率比较差异无统计学意义。临床高危特征低危组AAD诊断率也仅为1.41%;中危、高危2组分别为16.78%和55.56%;随着临床高危特征危险度越高,AAD诊断率越高(均P<0.05)。结论:突发疼痛的严重程度不能全面预判AAD诊断,仅在轻度疼痛中具有阴性预判作用。而临床高危特征评分是目前预判AAD诊断的良好指标,对低危组具有阴性价值,对中危、高危组具有较高的预判AAD诊断价值,尤其是对高危组具更高的预判诊断价值。
OBJECTIVE: To find out the clinical indications of acute simple acute dissection (AAD) diagnosed by rapid and simple emergency to instruct emergency physicians to quickly and correctly select the relevant examinations so as to confirm the diagnosis as soon as possible. Methods: A total of 902 emergency patients with sudden pain (chest pain, back pain, sudden pain and metastatic pain) were observed from January 2013 to December 2016. The patients were divided into mild group, moderate group and severe group according to the scale of pain intensity. According to the clinical features, the patients were divided into low-risk group, moderate-risk group and high-risk group. The diagnostic rate of AAD in each group was observed. Results: A total of 902 patients with moderate and severe pain were found in all the 902 patients with sudden onset pain, accounting for a total of 793 cases. The diagnosis rate of AAD in mild pain group was only 0.61%, which was significantly lower than that of moderate and severe pain group (7.32%, 7.58% P <0.05). There was no significant difference in the diagnostic rates between moderate and severe groups. The diagnostic rate of AAD in low-risk group was only 1.41%, that in middle-risk group and high-risk group was 16.78% and 55.56%, respectively. With the higher risk of clinical features, the diagnostic rate of AAD was higher (all P <0.05) . Conclusion: The severity of sudden pain can not predict the diagnosis of AAD in a comprehensive way, and it has a negative predictive value only in mild pain. The score of clinical high-risk features is a good indicator of the prognosis of AAD at present, which has a negative value for low-risk group and a higher diagnostic value of AAD for medium- and high-risk groups, especially for high-risk groups Diagnostic value.