摘要
目的 建立高分级动脉瘤性蛛网膜下腔出血（aSAH）显微外科的术前风险评分,并评价该评分对预后预测的准确性.方法 回顾性纳入2010年10月至2014年4月国内10家医疗中心采用显微外科手术治疗的世界神经外科联合会分级（WFNS）4级或5级的aSAH患者119例,根据年龄、WFNS分级、有无脑疝、有无脑室积血行术前风险评分（0～5分）.随访6～28（12.5±3.4）个月,采用改良Rankin量表评分（mRS）评估预后,将患者分为预后良好（mRS为0～3分）和预后不良（mRS为4～6分）.采用受试者工作特征曲线（ROC）评价风险评分预测预后的准确性.结果 119例患者中,59例（49.6％）预后良好;60例（50.4％）预后不良,其中37例死亡（31.0％）.术前风险评分不同者预后差异有统计学意义（x^2=42.077,P＜0.01）;其中术前评分≤1分者,预后不良的发生率为21.2％（（11/52）;术前评分≥4分者,预后不良的比例为8/9,术前评分越高,预后不良的发生率越高.该评分预测预后不良的曲线下面积=0.79（95％ CI：0.71 ～0.87,P＜0.01）,术前评分为2分,提示预后不良的灵敏度为82％,特异度为70％,拟合优度良好（x2=2.388,P=0.496）.结论 术前风险评分有助于预测显微外科手术治疗的aSAH患者的预后.
Objectives To develop a risk score before microsurgery for poor-grade aneurysmal subarachnoid hemorrhage （aSAH） and to evaluate the score for the accuracy of predicting prognosis.Methods A total of 119 patients with aSAH （World Federation of Neurosurgical Societies [WFNS] grade 4-5） treated with microsurgery in several medical centers in China from October 2010 to April 2014 were enrolled retrospectively.Preoperative risk scores （0-5 score） were conducted according to their age,WFNS score,having cerebral hernia or not,and having ventricle hematocele or not.They were followed up for 6-28 （12.5 ± 3.4） months.The modified Rankin scale （mRS） was used to evaluate the prognosis.The patients were divided into good prognosis （mRS 0-3） and poor prognosis （mRS 4-6）.Receiver operating characteristic （ROC） curve was used to evaluate the risk score for the accuracy of predicting prognosis.Results Fifty-nine patients （49.6%） had good prognosis,60 （50.4%） had poor prognosis and 37 of them died （31.0%）.There were significant prognosis differences in patients with different preoperative risk scores （x2 =42.077,P 〈 0.01）.In patients with preoperative score ≤ 1,the incidence of poor prognosis was 21.2% （11/52）;preoperative score ≥ 4,the proportion of poor prognosis was 8/9.The higher the preoperative score,the higher the incidence of poor prognosis.The area under the curve of this score predicting poor prognosis was 0.79 （95% CI 0.71-0.87,P 〈0.01）.If the preoperative score was 2,it suggested that the sensitivity of poor prognosis was 82%,the specificity was 70%,and the goodness of fit was good （x^2 =2.388,P =0.496）.Conclusion Preoperative risk score is helpful in predicting the prognosis of patients with aSAH who were treated with microsurgery.
出处
《中华神经外科杂志》
CSCD
北大核心
2016年第7期671-674,共4页
Chinese Journal of Neurosurgery
基金
国家科技支撑计划（2011BA108806,2013BA109803）
卫生部科研基金（WKJ20102-016）
