影响基底动脉尖综合征病人临床预后的因素研究

目的:探讨影响基底动脉尖综合征（TOBS）病人临床预后的因素。方法:纳入50例TOBS病人，根据发病后30 d改良Rankin预后等级量表评分结果将病人分为预后良好组（0~3分）和预后不良组（4~6分）。比较2组病人入院时的一般资料、MRI相关影像学表现、发病原因和美国国立卫生院神经功能缺损评分（NIHSS）、格拉斯哥评分量表（GCS）评分。结果:2组病人发病原因构成差异有统计学意义（P<0.01），预后不良组发病原因以栓塞为主（82.1%）。2组病人病变部位构成差异有统计学意义（P<0.01），其中预后不良组以混合部位为主（71.4%）。预后不良组病人入院时NIHSS评分明显高于预后良好组，GCS评分明显低于预后良好组（P<0.01）。结论:入院时经诊断为栓塞型、混合累及幕上幕下的病人，临床预后较差，应对诊疗方案加以优化，以降低TOBS的致残致死率；联合NIHSS评分及GCS评分，有助于对TOBS的病情、预后做出有效评价。

Study on the factors influencing the clinical prognosis of patients with top of the basilar syndrome

Objective:To explore the factors influencing the clinical prognosis of patients with top of the basilar syndrome(TOBS).Methods:A total of 50 patients with TOBS were divided into the favorable outcome group(MRS 0-3) and unfavorable outcome group(MRS 4-6) according to the MRS after 30 d of onset.The general information on admission,imaging findings,National Institutes of Health Stroke Scale(NIHSS) score and Glasgow Coma Scale(GCS) score between two groups were compared.Results:The difference of the pathogenesis between two groups was statistically significant(P<0.01),and the embolism was the main pathogenesis in unfavorable outcome group(82.1%).The difference of the lesion location between two groups was statistically significant(P<0.01),and the mix lesion was the main in unfavorable outcome group(71.4%).The NIHSS score and GCS score in unfavorable outcome group were significantly higher and lower than that in favorable outcome group,respectively(P<0.01).Conclusions:The clinical prognosis in patients with embolism,upper and lower tentoriums cerelelli involved are poor.The diagnosis and treatment plan should be optimized to reduce the fatality rate of TOBS handicap.The combined score of NIHSS and GCS may effectively evaluate the disease and prognosis of TOBS.