PESI和Wells评分对急性肺栓塞患者生存状况的预测效果  

Value of PESI and Wells score for predicting the prognosis of patients with acute pulmonary embolism

作　　者：李志波[1] 林淑媚[1] 冯起校[1] 

机构地区：[1]中山市陈星海医院呼吸与危重症医学科,广东中山528415

出　　处：《临床肺科杂志》2015年第10期1873-1875,1882,共4页Journal of Clinical Pulmonary Medicine

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44例确诊为急性肺栓塞患者进行回顾性分析,收集临床资料,追踪患者结局。分析患者的危险因素、临床症状,使用Ordinal回归分析Wells评分系统和PESI评分系统对急性肺栓塞患者预后判断的指导作用。结果急性肺栓塞患者的危险因素有外科手术、慢阻肺、冠心病、脑血管病、静脉血栓病史、恶性肿瘤;常见临床症状为呼吸困难、胸痛、咳嗽、咯血;常见体征为心率加快、呼吸频率加快;Wells分级低度危险、中度危险和高度危险的患者分别为4例,28例,12例,各组生存时间差别无统计学意义(P>0.05);PESI分级,1级、2级、3级、4级、5级患者分别为9例、13例、7例、6例、9例,各组患者生存时间差别有统计学意义(P<0.05)。结论急性肺栓塞患者危险因素较多,临床症状和体征无特异性;Wells评分对患者的预后判断无明显意义,PESI评分可较好判断患者病情,分级越高,预后越差。Objective To analysis the clinical characteristics and prognosis of patients with acute pulmonary embolism, and to explore the value of Pulmonary Embolism Severity Index and Wells scores in patients with acute pulmonary embolism. Methods The clinical data of 44 patients with acute pulmonary embolism were retrospectively collected to analyze their clinical characteristics and risk factors. Ordinal regression was used to explore the prognosis evaluation of the two scoring systems in acute pulmonary embolism patients. Results The risk factors of acute pulmonary embolism patients included surgery, COPD, coronary disease, cerebrovascular disease, a history of venous thrombosis, and tumor. The clinical characteristics included dyspnea, chest pain, cough and emptysis. The sign included high heart rate and high breath rate. According to Wells scores, 4 cases were divided into the low risk group, 28 cases into the middle risk group, and 12 cases into high risk group, and the survival time among the three groups showed no significant difference （ P 〉 0.05）. By PESI score, there were 9 cases into class one, 13 cases into class two, 7 cases into class three, 6 cases into class four, 9 cases into class five, and the survival time among these groups were significantly different （P 〈 0. 05）. Conclusion There are many risk factors of acute pulmonary embolism patients, and their clinical characteristics are non-specific. The Wells score is meaningless to indicate the patient＇s prognosis, while the PESI can predict the prognosis, that is the higher level of PESI indicates the worse prognosis.

关 键 词：急性肺栓塞 PESI WELLS评分 预后 

分 类 号：R563.5[医药卫生—呼吸系统]