改良HEART评分法对急诊胸痛患者分层治疗的指导价值研究  

A Study on the Guiding Value of the Improved HEART Grading Method for the Treatment of Patients with Emergency Chest Pain

作　　者：王繁麟 余娇[1] 王伟[1] 钱立[1] 吴嘉骏[1] 徐兵[1] WANG Fan-lin;YU Jiao;WANG Wei;QIAN Li;WU Jia-jun;XU Bing(Ninth People＇s Hospital Affiliatedto Shanghai Jiaotong University School of Medicine Emergencyinte malmedicing Shanghai,200011.China)

机构地区：[1]上海交通大学医学院附属第九人民医院急诊内科,上海200011

出　　处：《现代生物医学进展》2018年第15期2878-2881,2889,共5页Progress in Modern Biomedicine

基　　金：上海高校青年教师培养资助计划项目(Zzjdyx13102)

摘　　要：目的:研究改良HEART评分法对急诊胸痛患者分层治疗的指导价值。方法:选择我院急诊科收治的急性胸痛患者197例,根据疾病分为心源性胸痛组(n=132)和非心源性胸痛组(n=65),所有患者均行改良HEART评分和传统HEART评分,并根据评分进行危险分层,比较患者去向,建立受试者工作特征(ROC)曲线,评价HEART评分对危险分层和预后预测的价值。结果:心源性胸痛组改良HEART评分和常规HEART评分均高于非心源性胸痛组,两组改良HEART评分和常规HEART评分比较差异有统计学意义(P<0.05)。改良HEART评分低危者100%未住院,中危62.71%住院,高危住院、入ICU的构成比例为73.17%、36.59%;HEART评分低危11.11%住院,中危住院、入ICU的构成比例为57.38%、6.56%,高危住院、入ICU的构成比例为68.57%、31.43%,差异有统计学意义(P<0.05)。改良HEART评分用于对心源性胸痛患者分层的AUC值为0.916,敏感度为0.883,明显高于HEART评分的0.831和0.765。结论:改良HEART评分法可提高急诊胸痛患者分层的准确性,对指导患者去向和治疗价值较高。Objective： To study the guiding value of the improved HEART score in treating patients with acute chest pain. Methods：197 cases of patients with acute chest pain in our hospital emergency department were selected and divided into the cardiac chest pain group（n=132） and the non cardiac chest pain group（n=65） according to the cause of disease, all the patients were given improved HEART scoring and conventional HEART scoring, risk stratification according to the HEART score the destination was compared between the two groups of patients, the receiver-operating characteristic（ROC） curve was build to evaluate the value of improved HEART scoring for the risk stratification and prognosis. Results： The improved HEART score and HEART score of cardiac chest pain group were higher than those of the non cardiac chest pain group（P〈0.05）. 100% patients with low risk of improved HEART score was not hospitalized, and 62.71% of the patients were hospitalized, the proportion of high-risk hospitalization and ICU were 73.17% and 36.59%. The proportion of hospitalized patients admitted to the ICU were 57.38% and 6.56%, and the proportion of high-risk hospitalization and ICU were 68.57% and 31.43%（P〈0.05）. The AUC value of improved HEART score for risk stratification of patients with cardiac chest pain was 0.916 and the sensitivity was 0.883, which was significantly higher than of the HEART score（0.831 and 0.765）. Conclusion： The improved HEART score can improve the accuracy of risk stratification for he emergency chest pain patients, and it is of high value in guiding patients＇ prognosis and treatment.

关 键 词：改良HEART评分法 急诊 胸痛 分层治疗 指导价值 

分 类 号：R541.4[医药卫生—心血管疾病]