目的 探讨急性胸痛患者在急诊发生心肺衰竭的影响因素并构建风险预测模型。 方法 回顾性调查于某三级甲等医院急诊科就诊的4598名急性胸痛患者，计算急诊预检分诊时的休克指数（shock index,SI）、修正休克指数（modified shock index,MSI）、体温调整休克指数（temperature-adjusted shock index,ASI(T)）、年龄休克指数（age shock index,AgeSI）、舒张休克指数（diastolic shock index,DSI）、呼吸调整休克指数（respiratory-adjusted shock index,RASI）及改良早期预警评分（modified early warning score,MEWS）。根据是否发生心肺衰竭分组，以不同类型SI分别联合经皮血氧饱和度（percutaneous arterial oxygen saturation,SpO₂）和MEWS构建预测模型并采用受试者工作特征曲线下面积（area under curve,AUC）评价其预测价值。 结果 SI、MSI、ASI(T)、AgeSI、DSI、RASI和MEWS预测心肺衰竭的AUC为0.657、0.672、0.658、0.676、0.677、0.643、0.747；不同类型SI联合SpO₂、MEWS后预测心肺衰竭的AUC为0.838、0.843、0.837、0.837、0.845、0.829。 结论 基于DSI、SpO₂、MEWS构建的预测模型利于筛查急性胸痛患者中的心肺衰竭高危人群，对急性胸痛分诊、分级护理有一定指导价值。

Objective To explore the influencing factors of cardiopulmonary failure in emergency patients with acute chest pain and construct a risk prediction model. Methods A retrospective survey was conducted on 4598 patients with acute chest pain in the emergency department of a tertiary hospital,and the shock index (SI),modified shock index (MSI),temperature-adjusted shock index [ASI(T)],age shock index (AgeSI),diastolic shock index (DSI),respiratory-adjusted shock index (RASI) and modified early warning score (MEWS) were calculated during emergency pre-examination and triage.According to whether cardiopulmonary failure occurred or not,the predictive models were constructed by combining different types of SI with percutaneous oxygen saturation (SpO₂) and MEWS,and their predictive value was evaluated by the area under the curve (AUC). Results The AUCs of SI,MSI,ASI(T),AgeSI,DSI,RASI and MEWS for predicting cardiopulmonary failure were 0.657,0.672,0.658,0.676,0.677,0.643,0.747,respectively.The AUCs of different types of SI combined with SpO₂ and MEWS for predicting cardiopulmonary failure were 0.838,0.843,0.837,0.837,0.845 and 0.829,respectively. Conclusions The prediction model based on DSI,SpO₂ and MEWS can help to screen the high-risk population of cardiopulmonary failure in patients with acute chest pain,and has certain guiding value for the triage and graded nursing of acute chest pain.

R473.54

安徽省高等学校省级质量工程项目（2020jyxm2309）