红旗症状预警规则库与案例集

{
  "rule": {
    "chief_complaint": "腹痛",
    "trigger_required": [
      "突然发生的剧烈腹痛或腰背痛,一开始就最痛,持续不缓解",
      "具备以下任一项:已知腹主动脉瘤或主动脉夹层病史、自觉腹部有随心跳搏动的包块、疼痛像撕裂一样并向腰背/下肢窜"
    ],
    "trigger_enhancing": ["年龄≥60岁、长期高血压、吸烟", "晕倒或眼前发黑、面色苍白出冷汗", "一侧下肢发凉麻木"],
    "population_modifier": ["≥60岁高血压男性、马凡综合征、既往主动脉手术者:任何突发剧烈腹背痛即按本条"],
    "suspected_condition": [
      {
        "name": "腹主动脉瘤破裂/先兆破裂",
        "icd10": "I71.3"
      },
      {
        "name": "主动脉夹层(累及腹主动脉)",
        "icd10": "I71.0"
      },
      {
        "name": "肠系膜动脉夹层",
        "icd10": "I72.8"
      }
    ],
    "level": "L0",
    "action_text": "立即拨打120,说明“突发剧烈腹背痛,怀疑腹主动脉瘤/夹层”。患者绝对静卧、禁食禁水、避免用力咳嗽或排便;由救护车送至有血管外科/介入能力的医院。",
    "contraindication_text": "不要服用阿司匹林等抗血小板/抗凝药;不要按摩腹部;不要自行驾车。",
    "source": [
      {
        "title": "475腹主动脉瘤腔内治疗临床路径",
        "year": 2016,
        "section": "诊断依据 1.腹部搏动感、腹痛、腹胀;2.脐周或中上腹部搏动性肿块",
        "authorization": "公开件"
      },
      {
        "title": "主动脉夹层（内科）临床路径（2019年版）",
        "year": 2019,
        "section": "（二）诊断依据 1.临床表现(1)突发持续剧烈撕裂样疼痛,可延伸至腹部、腰部、下肢",
        "authorization": "公开件"
      }
    ],
    "evidence_grade": "专家意见"
  },
  "cases": [
    {
      "case_type": "阳性",
      "case_text": "我公公72岁有高血压,刚才突然喊肚子和腰一下子剧疼,像撕开一样往腿上窜,一下就疼到极点,脸色发白。",
      "expected_level": "L0",
      "rationale": "突发剧痛即达峰+撕裂样向下肢窜+老年高血压+苍白。",
      "trigger_hits": ["突然发生的剧烈腹痛或腰背痛,一开始就最痛,持续不缓解", "疼痛像撕裂一样并向腰背/下肢窜", "年龄≥60岁、长期高血压", "面色苍白出冷汗"]
    },
    {
      "case_type": "阴性",
      "case_text": "我30岁,昨天搬东西后腰两边酸疼,弯腰更明显,躺着好一些,血压正常,肚子不疼。",
      "expected_level": "L3",
      "rationale": "肌肉骨骼性腰痛,无突发剧烈/撕裂/包块,不命中。",
      "trigger_hits": []
    },
    {
      "case_type": "边界",
      "case_text": "我查出过腹主动脉瘤还没手术,今天肚子隐隐地疼了两个小时,不算剧烈,摸着肚子那里跳。",
      "expected_level": "L0",
      "rationale": "已知腹主动脉瘤+腹痛+搏动感,虽不剧烈,人群修饰按本条 L0(先兆破裂)。",
      "trigger_hits": ["已知腹主动脉瘤", "自觉腹部有随心跳搏动的包块"]
    }
  ]
}