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目的:探讨临床量表在老年非高危急性肺栓塞诊断中的预测价值。方法:根据2008年欧洲新版急性肺栓塞诊疗流程指南,连续收集在急诊诊治的268例可疑老年非高危肺栓塞患者的临床资料,分别进行Wells量表、Geneva量表和修正Geneva量表评估,并与最终确诊结果进行比较。结果:268例可疑老年非高危肺栓塞患者中,确诊为非高危肺栓塞78例;Wells量表、Geneva量表和修正Geneva量表高可能性组的阳性预测值分别为48.57%(34/70)、45.21%(33/73)和46.05%(35/76),低可能性组的阴性预测值分别为87.96%(95/108)、86.41%(89/103)和90.91%(100/110)。诊断肺栓塞的阳性似然比、阴性似然比、Youden指数和一致性系数Wells量表分别为2.30、0.70、0.24和0.254,Geneva量表分别为2.01、0.73、0.21和0.217,修正Geneva量表分别为2.08、0.703、0.23和0.235。3种量表对肺栓塞诊断的敏感度、特异度比较差异无统计学意义。结论:3种临床量表在非高危急性肺栓塞筛查中具有一定的预测价值,且预测效率差异无统计学意义。
Objective: To investigate the predictive value of clinical scales in the diagnosis of non-high-risk acute pulmonary embolism in the elderly. Methods: The clinical data of 268 patients with suspected non-high risk pulmonary embolism in the emergency department were collected continuously according to the 2008 European guidelines for the treatment of acute pulmonary embolism. The Wells scale, the Geneva scale and the revised Geneva scale were evaluated respectively. Compared with the final diagnosis. Results: Among 268 suspected non-high-risk PE patients, 78 were diagnosed as non-high risk pulmonary embolism. The positive predictive values of the Wells, Geneva and revised Geneva scales were 48.57% (34/70 ), 45.21% (33/73) and 46.05% (35/76) respectively. The negative predictive value of low probability group were 87.96% (95/108), 86.41% (89/103) and 90.91% (100/110 ). The positive likelihood ratio, negative likelihood ratio, Youden index and Coefficient of Wells scale for diagnosis of pulmonary embolism were 2.30, 0.70, 0.24 and 0.254, respectively, and the Geneva scale was 2.01, 0.73, 0.21 and 0.217, respectively. Respectively, 2.08,0.703,0.23 and 0.235.3 kinds of scales for the diagnosis of pulmonary embolism sensitivity, specificity was no significant difference. Conclusion: The three clinical scales have some predictive value in the screening of non-high-risk acute pulmonary embolism, and the predictive efficiency has no statistical significance.