肺栓塞严重程度指数（PESI）与Wells评分系统在急性肺栓塞预后评价中的作用  

The pulmonary embolism severity index and WELLS scores in predicting the prognosis of patients with acute pulmonary embolism

作　　者：邓跃林[1] 徐术根[1] 邓超 

机构地区：[1]中南大学湘雅医院急诊科,湖南长沙410008 [2]湘雅医学院2011级

出　　处：《中国急救医学》2014年第1期67-70,共4页Chinese Journal of Critical Care Medicine

基　　金：中南大学研究生教改创新课题（20100036）

摘　　要：目的分析急性肺栓塞患者的临床特点和预后，探讨两种评分系统在急性肺栓塞患者预后评估中的应用价值。方法对中南大学湘雅医院及长沙市中心医院2002—01—2010—09收治的84例确诊为急性肺栓塞患者的一般资料、临床表现及预后进行回顾性研究和分析。结果①急性肺栓塞患者常见症状包括呼吸困难、胸痛、咯血、心悸等，发生率依次为35．3％、31．8％、31．8％、28．2％；急性肺栓塞常见的体征为心率增快、颈静脉怒张、呼吸频率增快等，发生率依次为41．2％、22．4％、21．2％。②85例急性肺栓塞患者Wells分级低危6例、中危55例、高危24例，比例分别为7％、65％、28％，组间生存时间比较差异无统计学意义（P〉0．05）。③将85例急性肺栓塞患者予以PESl分级，其中1级19例，占22．4％，其中住院死亡率及生存时间少于1个月者为0；2级患者25例，占29．4％，其中无患者死于住院期间，生存时间少于1个月者5例（20％）；3级患者14例，占16．5％，其中死于住院期间者1例（7．1％），生存时间少于1个月者6例（42．9％）；4级患者12例，占14．1％，其中死于住院期间者4例（33．4％），生存时间少于1个月者6例（50％）；5级患者15例，占17．6％，其中死于住院期间者10例（66．7％），生存时间少于1个月者5例（33．3％）。追踪患者预后，运用Ordinal回归分析，组问患者生存时间比较差异有统计学意义（P〈0．05）。结论①急性肺栓塞患者临床症状及体征多样化、无特异性，临床以呼吸困难、胸痛、心率增快、颈静脉怒张等常见；②Wells系统对急性肺栓塞患者预后判断无明显指导意义；③PESl分级能较好判断急性肺栓塞患者的病情危重程度，PESl分级越高，患者预后越差。Objective To analyze the clinical characteristics and the value of pulmonary embolism severity index （PESI） score and the Wells scores in the patients with acute pulmonary embolism （APE）. Methods Two hospitals （Xiangya Hospital of Center South University and the Center Hospital of Changsha City） in China were selected in this study. A totally of 85 patients with APE who admitted to those two hospitals from July 2002 to January 2011 were enrolled in this retrospective study. General information, clinical characteristics and prognosis were collected according to the medical record or a phone call, and the value of PESI and Wellis scores in predicting the APE patients＇prognosis was analyzed. Results ①The APE patients＂ common clinical features included dyspnea, chest pain, emptysis, heart - throp, high heart - rate, high breath - rate and incidence of those clinical features was 35.3%, 31.8%, 31.8%, 28.2%, 41.2% and 21.2%, respectively. ②Among the 85 APE patients, there were 6 cases in the low possibility group, 25 cases in the middle possibility group and 24 cases in high possibility group of Wells score; its ratio was 7%, 65% and 28%, respectively; but the survival time among these groups were not significantly difference. ③When the 85 APE patients were classifiedby PESI score system, there were 19 cases in class one, 25 cases in class two, 14 cases in class three, 12 cases in class four and 15 cases in class five; its ratio was 22.4%, 29.4%, 16.5%, lg. 1% and 17.6%, respectively; the survival time between different groups varied markedly. Conclusion The APE patients＂ clinical features are nonspecific. The Wells scores have no prediction effect on the prognosis of APE patients. The higher level of PESI when the patient admitted, the higher mortality rate, the PESI classification can predict the patients prognosis very well.

关 键 词：急性肺栓塞 临床表现 Wells评分系统 严重程度指数(PESI) 预后 

分 类 号：R563.5[医药卫生—呼吸系统]