全球急性冠状动脉事件注册评分与非ST段抬高型急性冠脉综合征患者急诊危重度指数的相关性分析
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摘要
目的分析全球急性冠状动脉事件注册(GRACE)评分与非ST段抬高型急性冠脉综合征(NSTE-ACS)患者急诊危重度指数(ESI)的相关性。方法选取2016年4月—2017年4月南通大学附属医院胸痛中心上报到卫生部中国胸痛中心网站上的411例NSTE-ACS患者,其中ESIⅠ级7例、Ⅱ级127例、Ⅲ级133例、Ⅳ89例、Ⅴ级55例。收集患者年龄、心率、收缩压、Killip分级、血肌酐及危险因素(包括ST段压低、肌钙蛋白及院前心搏骤停)以计算GRACE评分,GRACE评分及其条目与NSTE-ACS患者ESI的相关性分析采用Spearman秩相关分析。结果 Spearman秩相关分析结果显示,GRACE评分(r_s=-0.600)及年龄(r_s=-0.321)、Killip分级(r_s=-0.243)、血肌酐(r_s=-0.151)、ST段压低(r_s=-0.459)、肌钙蛋白升高(r_s=-0.459)、院前心搏骤停(r_s=-0.124)与NSTE-ACS患者ESI呈负相关(P<0.05);心率(r_s=-0.064)、收缩压(r_s=-0.057)与NSTE-ACS患者ESI无直线相关关系(P>0.05)。结论 GRACE评分与NSTE-ACS患者ESI呈负相关,其可能成为NSTE-ACS患者急诊预检分诊的辅助工具。
Objective To analyze the correlation between GRACE score and ESI in patients with non ST-segment elevation acute coronary syndrome. Methods A total of 411 non ST-segment elevation acute coronary syndrome patients reported on China Chest Pain Center Website of Ministry of Health were selected in the Chest Pain Center of the Affiliated Hospital of Nantong Univer_sity from April 2016 to April 2017,thereinto 7 cases were Ⅰ-grade ESI,127 cases were Ⅱ-grade ESI,133 cases were Ⅲ-grade ESI,89 cases were Ⅳ-grade ESI,55 cases were Ⅴ-grade ESI.Age,heart rate,SBP,Killip grade,Scr and risk factor_s(including ST-segment depression,troponin and pre-hospital cardiac arrest)were collected to calculate GRACE score,Spearman rank correlation analysis was used to analyze the correlations of GRACE score and its clauses with ESI in patients with non ST-segment elevation acute coronary syndrome. Results Spearman rank correlation analysis results showed that,GRACE score(r_s=-0.600),age(r_s=-0.321),Killip grade(r_s=-0.243),Scr(r_s=-0.151),ST-segment depression(r_s=-0.459),elevation of troponin(r_s=-0.459)and pre-hospital cardiac arrest(r_s=-0.124)was negatively correlated with ESI in patients with non ST-segment elevation acute coronary syndrome(P<0.05),while no linear correlation was found between heart rate(r_s=-0.064),SBP(r_s=-0.057) and ESI(P>0.05). Conclusion GRACE score is negatively correlated with ESI in patients with non ST-segment elevation acute coronary syndrome,may be a auxiliary mean of emergency triage for non ST-segment elevation acute coronary syndrome.
Objective To analyze the correlation between GRACE score and ESI in patients with non ST-segment elevation acute coronary syndrome. Methods A total of 411 non ST-segment elevation acute coronary syndrome patients reported on China Chest Pain Center Website of Ministry of Health were selected in the Chest Pain Center of the Affiliated Hospital of Nantong Univer_sity from April 2016 to April 2017,thereinto 7 cases were Ⅰ-grade ESI,127 cases were Ⅱ-grade ESI,133 cases were Ⅲ-grade ESI,89 cases were Ⅳ-grade ESI,55 cases were Ⅴ-grade ESI.Age,heart rate,SBP,Killip grade,Scr and risk factor_s(including ST-segment depression,troponin and pre-hospital cardiac arrest)were collected to calculate GRACE score,Spearman rank correlation analysis was used to analyze the correlations of GRACE score and its clauses with ESI in patients with non ST-segment elevation acute coronary syndrome. Results Spearman rank correlation analysis results showed that,GRACE score(r_s=-0.600),age(r_s=-0.321),Killip grade(r_s=-0.243),Scr(r_s=-0.151),ST-segment depression(r_s=-0.459),elevation of troponin(r_s=-0.459)and pre-hospital cardiac arrest(r_s=-0.124)was negatively correlated with ESI in patients with non ST-segment elevation acute coronary syndrome(P<0.05),while no linear correlation was found between heart rate(r_s=-0.064),SBP(r_s=-0.057) and ESI(P>0.05). Conclusion GRACE score is negatively correlated with ESI in patients with non ST-segment elevation acute coronary syndrome,may be a auxiliary mean of emergency triage for non ST-segment elevation acute coronary syndrome.
引文
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[3]李红,秦俊春,周越.急诊科护士分诊时初筛胸痛患者心电图在诊断急性冠状动脉综合征的作用[J].华西医学,2016,31(4):750-752.
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[8]中华人民共和国卫生部.急诊病人病情分级试点指导原则(征求意见稿)[J].中华危重症医学杂志,2011,4(4):241-243.
[9]AMSTERDAM E A,WENGER N K,BRINDIS R G,et al.2014AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes:a report of the American College of Cardiology/American Heart Association Task Force on Practic eGuidelines[J].J Am Coll Cardiol,2014,64(24):e139-228.DOI:10.1016/j.jacc.2014.09.017.
[10]GRANGER C B,GOLBERG R J,DABBOUS O H,et al.Predictors of hospital mortality in the global registry of acute coronary events[J].Arch Intern Med,2003,163(19):2345-2353.
[11]张韶辉,刘立新,魏广和,等.GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估[J].中国循环杂志,2015,30(8):728-732.DOI:10.3969/j.issn.1000-3614.2015.08.003.
[12]GILBOY N,TRAVERS D,WUERZ R.Re-evaluating triage in the new millennium:a comprehensive look at the need for standardization and quality[J].J Emerg Nurs,1999,25(6):468-473.
[13]G O O D M A NSG, H U A N GW, Y A NAT, e ta l. T h e expanded Global Registry of Acute Coronary Events:baseline characteristics,management practices and hospital outcomes of patients with acute coronary syndromes[J].Am Heart J,2009,158(2):193-201,e1-5.DOI:10.1016/j.ahj.2009.06.003.
[14]戎清,宋晓莉.GRACE评分系统应用于急性冠脉综合征患者围手术期的护理效果[J].中国循证心血管医学杂志,2016,8(5):573-575.DOI:10.3969/j.issn.1674-4055.2016.05.18.
[2]ROFFI M,PATRONO C,COLLET J P,et a1.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.DOI:10.1093/eurheartj/ehv320.
[3]李红,秦俊春,周越.急诊科护士分诊时初筛胸痛患者心电图在诊断急性冠状动脉综合征的作用[J].华西医学,2016,31(4):750-752.
[4]GILBOY N,TANABE T,TRAVERS D,et a1.Emergency Severity Index(ESI):a triage tool for emergency department care,version4.Implementation handbook 2012 edition[M].Rockville:Agency for Healthcare Research and Quality,2011.
[5]SANTOS A P,FREITAS P,MARTINS H M G.Manchester triage system VersionⅡand resource utilisation in the emergency deparment[J].Emerg Med J,2014,31(2):148-152.DOI:10.1136/emermed-2012-201782.
[6]BULLARD M J,UNGER B,SPENCE J,et al.Revisions to the Canadian Emergency Deparment Triage and Acuity Scale(CTAS)adult guidelines[J].CJEM,2008,10(2):136-151.
[7]TANABE P,GIMBEL R,YARNOLD P R,et al.Reliability and validity of scores on The Emergency Severity Index version 3[J].Acad Emerg Med,2004,11(1):59-65.
[8]中华人民共和国卫生部.急诊病人病情分级试点指导原则(征求意见稿)[J].中华危重症医学杂志,2011,4(4):241-243.
[9]AMSTERDAM E A,WENGER N K,BRINDIS R G,et al.2014AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes:a report of the American College of Cardiology/American Heart Association Task Force on Practic eGuidelines[J].J Am Coll Cardiol,2014,64(24):e139-228.DOI:10.1016/j.jacc.2014.09.017.
[10]GRANGER C B,GOLBERG R J,DABBOUS O H,et al.Predictors of hospital mortality in the global registry of acute coronary events[J].Arch Intern Med,2003,163(19):2345-2353.
[11]张韶辉,刘立新,魏广和,等.GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估[J].中国循环杂志,2015,30(8):728-732.DOI:10.3969/j.issn.1000-3614.2015.08.003.
[12]GILBOY N,TRAVERS D,WUERZ R.Re-evaluating triage in the new millennium:a comprehensive look at the need for standardization and quality[J].J Emerg Nurs,1999,25(6):468-473.
[13]G O O D M A NSG, H U A N GW, Y A NAT, e ta l. T h e expanded Global Registry of Acute Coronary Events:baseline characteristics,management practices and hospital outcomes of patients with acute coronary syndromes[J].Am Heart J,2009,158(2):193-201,e1-5.DOI:10.1016/j.ahj.2009.06.003.
[14]戎清,宋晓莉.GRACE评分系统应用于急性冠脉综合征患者围手术期的护理效果[J].中国循证心血管医学杂志,2016,8(5):573-575.DOI:10.3969/j.issn.1674-4055.2016.05.18.