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Stroke：基底动脉卒中24至48h内神经系统检查可预测预后

2016-10-04 xing.T MedSci原创

基底动脉闭塞性卒中
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由此可见，24至48小时内的NIHSS评分可以准确预测急性基底动脉闭塞患者一个月内的不良预后和病死率，其可为基底动脉闭塞患者的护理提供有价值的临床预后判断。

准确预测基底动脉闭塞卒中患者长期预后可指导在亚急性期的临床管理，近日，卒中领域权威杂志《Stroke》上发表了一篇研究文章，旨在确定后续采用美国国立卫生院卒中量表（NIHSS）进行神经系统检查的判断预后价值，以及识别基底动脉闭塞患者24-48小时内NIHSS风险类别。

研究者纳入的619名参与者均通过影像学证实为急性基底动脉闭塞的患者，研究者收集了24至48小时内的NIHSS评分以及1个月的改良Rankin量表评分。采用单变量以及多变量模型以确定不良预后的独立预测指标，通过ROC曲线来确定基线和24至48个小时内的NIHSS评分对不良预后（改良Rankin量表为4–6）的预测能力和1个月的死亡率。

研究者发现376名急性基底动脉闭塞患者（65.4%）有不良预后，在多变量分析中，发现24至48小时内的NIHSS评分（比值比为1.28 [1.21–1.35]）、轻度卒中史（比值比为2.64 [1.04–6.74]）、治疗时间超过6小时（比值比为3.07 [1.35–6.99]）、年龄（比值比为1.02
[0.99–1.04]）都可以作为不良预后的预测指标。对1个月内的不良预后（曲线下面积的0.92 vs 0.75）和死亡率（曲线下面积的0.85 vs 0.72）的预测，24至48小时内的NIHSS评分的预后能力远高于基线NIHSS评分。分类和回归树分析确定了五个24至48小时内的NIHSS评分风险分类与不良预后发生率，其分别为9.4%（NIHSS 0–4）、36%（NIHSS评分5–11）、84.3%（NIHSS评分12–22）、96.1%（NIHSS评分23–27），和100%（NIHSS≥28）。

由此可见，24至48小时内的NIHSS评分可以准确预测急性基底动脉闭塞患者一个月内的不良预后和病死率，其可为基底动脉闭塞患者的护理提供有价值的临床预后判断。

原始出处：

Srikant Rangaraju, et al. Neurologic Examination at 24 to 48 Hours Predicts Functional Outcomes in Basilar Artery Occlusion Stroke. Stroke. 2016. 

本文系梅斯医学（MedSci）原创编译整理，转载需授权！

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  1. 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createdName=inter158, createdTime=Thu Oct 06 02:01:29 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140204, encodeId=8e06140204fb, content=谢谢分享，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:58 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140203, encodeId=4704140203fd, content=学习啦，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:53 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140202, encodeId=8e801402027a, content=那就早判断吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:46 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140201, encodeId=fa49140201dc, content=基底动脉卒中24至48h内神经系统检查可预测预后, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, 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    2016-10-19 cjingjuan

    ，24至48小时内的NIHSS评分可以准确预测急性基底动脉闭塞患者一个月内的不良预后和病死率

    0

  2. 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    2016-10-06 luoxiaog

    #神经系统#

    0

  3. 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    2016-10-06 HinsMax

    #基底动脉#

    0

  4. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545828, encodeId=6cb815458287f, content=<a href='/topic/show?id=a41642049ac' target=_blank style='color:#2F92EE;'>#基底动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42049, encryptionId=a41642049ac, topicName=基底动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10fb13820247, createdName=HinsMax, createdTime=Thu Oct 06 02:10:00 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140698, encodeId=c57214069847, content=24至48小时内NIHSS评分可以准确预测急性基底动脉闭塞患者一个月内的不良预后和病死率，, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Thu Oct 06 02:01:29 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140204, encodeId=8e06140204fb, content=谢谢分享，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:58 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140203, encodeId=4704140203fd, content=学习啦，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:53 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140202, encodeId=8e801402027a, content=那就早判断吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:46 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140201, encodeId=fa49140201dc, content=基底动脉卒中24至48h内神经系统检查可预测预后, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, 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objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-06 inter158

    24至48小时内NIHSS评分可以准确预测急性基底动脉闭塞患者一个月内的不良预后和病死率，

    0

  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:11 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140136, encodeId=b1b614013652, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Oct 04 22:04:02 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139947, encodeId=bf6513994e73, content=可为基底动脉闭塞患者的护理提供有价值的临床预后判断！, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 医路开来

    谢谢分享，，

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 医路开来

    学习啦，，

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:53 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140202, encodeId=8e801402027a, content=那就早判断吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:46 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140201, encodeId=fa49140201dc, content=基底动脉卒中24至48h内神经系统检查可预测预后, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:11 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140136, encodeId=b1b614013652, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Oct 04 22:04:02 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139947, encodeId=bf6513994e73, content=可为基底动脉闭塞患者的护理提供有价值的临床预后判断！, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 医路开来

    那就早判断吧

    0

  8. 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objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 医路开来

    基底动脉卒中24至48h内神经系统检查可预测预后

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:11 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140136, encodeId=b1b614013652, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Oct 04 22:04:02 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139947, encodeId=bf6513994e73, content=可为基底动脉闭塞患者的护理提供有价值的临床预后判断！, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 刘煜

    学习了谢谢。

    0

  10. 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createdName=inter158, createdTime=Thu Oct 06 02:01:29 CST 2016, time=2016-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140204, encodeId=8e06140204fb, content=谢谢分享，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:58 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140203, encodeId=4704140203fd, content=学习啦，，, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:53 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140202, encodeId=8e801402027a, content=那就早判断吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:46 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140201, encodeId=fa49140201dc, content=基底动脉卒中24至48h内神经系统检查可预测预后, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Oct 04 23:48:11 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=140136, encodeId=b1b614013652, content=学习了谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Oct 04 22:04:02 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139947, encodeId=bf6513994e73, content=可为基底动脉闭塞患者的护理提供有价值的临床预后判断！, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Tue Oct 04 14:46:47 CST 2016, time=2016-10-04, status=1, ipAttribution=)]
    2016-10-04 Carlos007

    可为基底动脉闭塞患者的护理提供有价值的临床预后判断！

    0

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