急性脑卒中早期临床诊断研究

目的：验证与探讨Besson评分法对急性脑卒中的早期诊断价值。方法：从1998年7月1日到9月30日住院的91例急性脑卒中病人，全部病人均经CT或／和MRI确诊。记录一般资料及Besson评分法中相应8个变量，应用SPSS软件包进行统计学分析。结果：双变量分析发现TIA较常见于非出血性脑卒中，而巴彬斯基征和头痛较常见于出血性脑卒中，Besson评分为有20例Z＜1，所有这些病人CT或／和MRI诊断为非出血性脑梗死，占非出血性脑死的38．46％的可信限为28．46％－48．46％，占总数的21．98％，95％可信限为13．47％－30．49％；对非出血性脑梗死的阳性预告值为100％。95％的可信限为83－100％，结论：TIA史在非出血性脑梗死中常见，而巴彬斯基征和头痛常见于出血性脑卒中；38．46％（95％的可信限为28．46％－48．46％）的非出血性脑梗死能够早期准确诊断，阳性预告值为100％（95％的可信限为83－100％），Besson量表简单，计算方便，与CT（MRI）符合率高。

The early clinical diagnosis of acute stroke

Objective To validate the Besson's score and test its ability to diagnose acute stroke. Methods Name, sex, age, CT(MRI) and the eight variables of Besson's score were recorded in patients.We used CT(MRI) as the gold standard. All datum analyses were performed with SPSS. Results 91 patients were enrolled. The bivariate analysis of the eight variables shows that a history of TIA was significantly more frequent in patients with nonhemorrhagic stroke, whereas plantar response and headache were significantly more frequent in patients with hemorrhagic stroke. We applied Besson's score to the 91 patients. 20 patients who had a nonhemorrhagic infarct on CT had a score less than 1, 38.46% of all patients with nonhemorrhagic infarct. The emipirical positive predictive value in the diagnosis of nonhemorrhagic infarct was 100%, yielding a 95% CI of 83 to 100. Conclusion A history of TIA was significantly more frequent in patients with nonhemorrhagic stroke, whereas plantar response and headache were significantly more frequent in patients with hemorrhagic stroke 38.46% (95% CI, 28.46 to 48.46 ) of patient with a nonhemorrhagic infarct could accurately receive a early bedside diagnosis. Besson's score can be easily calculated and is highly identical to CT (MRI).