目的 调查我国综合医院急诊科医护人员急性主动脉夹层预检分诊现状,为建立规范化的预检分诊流程提供借鉴。方法 采用便利抽样法,2022年6月—7月抽取中国东部、南部、西部、北部、中部5个地区的613名综合医院急诊科医护人员作为研究对象,采用“基于 HIRAID评估框架的急性主动脉夹层救治现状调查表”进行调查,分析急诊科急性主动脉夹层的急诊预检分诊现状。结果 在病史、识别风险因素环节上,16.80%的急诊科医护人员表示会借助急性主动脉夹层相关筛查工具进行分诊初筛;评估环节上,45.84%的急诊科医护人员表示并未主动测量症状典型的疑似急性主动脉夹层患者的四肢血压;不同区域、不同等级医院在主动脉夹层相关筛查工具应用、典型症状的疑似急性主动脉夹层患者四肢血压测量、胸痛患者急性冠脉综合征筛查等方面的差异具有统计学意义（均P<0.05） 。结论 综合医院急性主动脉夹层急诊预检分诊时相关筛查工具使用率不高;不同区域、不同等级医院急性主动脉夹层预检分诊质量差异较大。须建立适合各级医院急性主动脉夹层预检分诊管理机制,推动急性主动脉夹层急救预检分诊的标准化管理。
Objective to investigate the current situation of emergency pre-examination and triage for acute aortic dissection（AAD） in emergency departments of domestic general hospitals,and to provide reference for the establishment of standardized pre-examination and triage process for AAD. Methods Using convenient sampling method,613 emergency department medical staff from five regions across the country,including the eastern,southern,western,northern,and central regions,were selected as the research subjects from June to July 2022. The Current Survey of Acute Aortic Dissection based on HIRAID Evaluation Framework was used to analyze the current situation of emergency pre-examination and triage for AAD in the emergency department nationwide. Results In terms of medical history and identification of risk factors,16.80% of the emergency department medical staff said that they would use AAD related screening tools for initial triage screening. In the evaluation session,45.84% of the emergency department medical staff said that they did not actively measure the limb blood pressure of suspected patients with symptomatic typical AAD. There were significant differences in the application of screening tools related to AD,blood pressure measurement of limbs in suspected AAD patients with typical symptoms,and screening of acute coronary syndrome in patients with chest pain among different regions and different grades of hospitals（all P<0.05）. Conclusion The use rate of relevant screening tools was low in domestic general hospitals. There are significant differences in the quality of pre-examination and triage for AAD in hospitals of different regions and levels. It is necessary to establish a management mechanism suitable for pre-examination and triage of AAD in hospitals at all levels,and promote standardized management of emergency pre-examination and triage of AAD.
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