脑卒中常用量表对急性脑梗死患者死亡预测的价值

目的评价急性生理学和慢性健康状况评分(APACHEⅡ、APACHEⅢ)、改良的爱丁堡-斯堪的纳维亚评分(CSS)、美国国立卫生研究院卒中量表(NIHSS)评分、欧洲卒中评分(ESS)、既往史和伴发疾病评分对急性脑梗死患者预后评估的价值。方法选择441例急性脑梗死患者,在入院24 h内分别进行APACHEⅡ、APACHEⅢ、CSS、NIHSS、ESS、既往史和伴发疾病评分,并据患者发病后1个月时的预后分为生存组279例和死亡组162例,对2组患者的资料进行统计分析。通过ROC曲线评定分析6个量表对预后的预测价值。结果死亡组APACHEⅡ、APACHEⅢ、CSS、NIHSS和伴发疾病评分高于生存组(P<0.01),ESS评分低于生存组(P<0.01)。2组既往史评分比较差异无统计学意义(P>0.05)。APACHEⅡ、APACHEⅢ、CSS、NIHSS、ESS和伴发疾病评分6个量表预测急性脑梗死预后的ROC曲线下面积分别为0.867、0.858、0.896、0.876、0.886和0.841,差异有统计学意义(P<0.01),其预测界值分别为12、31、15、26、33和10分。结论 APACHEⅡ、APACHEⅢ、CSS、NIHSS、ESS和伴发疾病评分对急性脑梗死患者的预后均有较好的预测价值,预测准确度在75%左右。

Prognostic value of scoring systems for acute cerebral infarction of stroke patients

Objective To evaluate the scoring systems of cerebral thrombosis usually used for the prognosis in acute cerebral infarction.Methods 441 patients with acute cerebral infarction were tested with APACHEⅡ,APACHEⅢ,CSS,NIHSS,ESS and complication scale within 24 hours after admission.All of them were divided into two groups according to survival or death within 1 month after nosopoiesis.We evaluated the reality of these seven scales by making receiver operating character(ROC) curves and compared the areas under of the ROC.Results A significant difference was found between survivor and non-survivor group on the score of patients scored by APACHEⅡ,APACHEⅢ,NIHSS,CSS,ESS and complication scale,respectively(P<0.05).The. scores of non-survivor group were higher than that of survivor group by APACHEⅡ,APACHEⅢ, NIHSS,CSS and complication scale and lower than that of survivor group by ESS(P<0.05).The scale of past history did not show significant difference between survivor and non-survivor group (P>0.05).The areas under the ROC curves of APACHEⅡA,PACHEⅢ,NIHSS,CSS,ESS and complication scale were 0.867,0.858,0.896,0.876,0.886,0.841,respectively.Conclusion APACHEⅡ,APACHEⅢ,NIHSS,CSS,ESS and complication scale are superior to the others for predicting the status of survival or death of acute cerebral thrombosis.And the best cut-off points were 12,31,15,26,33 and 10,the accuracy of which was 75%approximately.