冯修武山东省梁山县人民医院儿科室，山东济宁　272600

肺栓塞严重指数变化对急性肺栓塞患者死亡率的预测价值

冯修武
山东省梁山县人民医院儿科室，山东济宁272600

目的 探讨肺栓塞严重指数（PESI）变化对急性肺栓塞（PE）患者死亡率的预测价值。方法 整群收集2013年3月—2015年3月该院收治的304例急性PE患者。患者入院时PESI分级Ⅲ，48 h后再次对其进行临床风险评估（PESI48和sPESI48），比较重新分级后的低危患者与中高危患者的30天全因死亡率和预后情况。结果48 h后，83例患者PESI48分级Ⅰ～Ⅱ，205例患者PESI48分级Ⅲ，16例患者PESI48分级Ⅳ～Ⅴ；入院时，250例患者sPESI≥1，48 h后，250例患者中的38例sPESI48=0。经PESI48重新分级后，低、中高危患者的30 d全因死亡率分别为1.2%和11.3%。经sPESI48重新分级后，低、中危患者30 d全因死亡率分别为0.0%和12.3%。PESI48预测急性PE患者死亡的敏感性、特异性、阳性预测值和阴性预测值分别为96.1%、29.5%、11.3%、98.8%；sPESI48预测急性PE患者死亡的敏感性、特异性、阳性预测值和阴性预测值分别为100.0%、30.2%、11.8%、100.0%。结论 计算PESI48和sPESI48可使患者分类至更准确的风险层次，有助于区分30 d死亡风险极低的患者。

肺栓塞严重指数；肺栓塞；死亡率；预后

［Abstract］Objective To investigate the predictive value of Pulmonary Embolism Severity Index（PESI）on mortality in patients with acute pulmonary embolism（PE）.Methods Group selection 304 patients with acute PE were collected from March 2013～2015 year in March in our hospital.When the patient is admitted to hospital PESI grade III，48 h after again the of clinical risk assessment and sPESI48 PESI48，compared the re classification of low-risk patients and in patients at high risk of 30 day all-cause mortality and prognosis.Results After 48 h，83 cases of patients PESI48 in grade I～II，205 patients PESI48 grade III，16 cases of patients PESI48 grade IV～V；admission，250 patients spesi is more than or equal to 1.After 48 h，250 cases of patients with 38 cases sPESI48=0.The PESI48 re classification，low and high risk patients 30 day all-cause mortality were 1.2%and 11.3%.The sPESI48 re classification，low and medium risk patients 30 day allcause mortality were 0%and 12.3%.Prediction of mortality in patients with acute PE sensitivity，specificity，positive predictive value and negative predictive value were 96.1%and 29.5%，11.3%，98.8%PESI48；sPESI48 predict mortality in patients with acute PE sensitivity，specificity，positive predictive value and negative predictive value was 100%，30.2%，11.8%and 100%respectively.Conclusion The calculation of PESI48 and sPESI48 can make the patient classification to more accurate risk levels，helps to distinguish between 30 day mortality in very low risk patients.

［Key words］Pulmonary Embolism Severity Index；Pulmonary embolism；Mortality；Prognosis

肺栓塞（PE）是临床常见的具有高复发率和致死率的血管疾病，溶栓和抗凝治疗是临床最有效的治疗措施。然而，急性PE患者短期预后差，致命性PE的复发风险高，通常需要入院治疗［1］。对急性PE患者进行早期死亡风险评估和分层有助于区分适合门诊治疗的低危患者。肺栓塞严重指数（PESI）和简化PESI（sPESI）是应用广泛的急性PE临床预后评分方法［2-3］。虽然PESI和sPESI可准确诊断1/3急性PE低危患者，但仍高估了多数患者的死亡风险。……