摘要
目的探讨WORSEN评分在预测急性缺血性脑卒中发生早期神经功能恶化的临床意义。方法采取方便采样方法,回顾深圳市某三级甲等医院神经内科2014年1月—2017年12月402例急性缺血性脑卒中,其中2014年1月—2016年12月份300例患者构成验证组1,2017年1—12月102例患者构成验证组2。入院24 h内对患者进行国立卫生院卒中研究量表评分,并采用WORSEN评分,对患者入院首次实验室及影像学检查结果进行评估,统计早期神经功能恶化发生率,根据受试者特征曲线、曲线下面积、约登指数、灵敏度和特异度判断其预测病情恶化的效能。结果 WORSEN评分与早期神经功能恶化发生率呈正相关(r=0.424,P<0.001),评分越高,发生早期神经功能恶化概率越大;2组患者中评分在0～7分,当WORSEN评分=3时,约登指数最大,是预测发生早期神经功能恶化的最佳界值;验证组1预测早期神经功能恶化的受试者特征曲线下面积为0.778(95%CI:0.710～0.845),灵敏度68.0%,特异度76.8%,准确度75.3%,阳性预测值37.0%,阴性预测值92.3%,与验证组2拟合度较好(χ~2=7.000,P=0.321)。结论 WORSEN评分能较好预测发生早期神经功能恶化概率,可以作为临床医护人员判断急性缺血性脑卒中患者病情进展的评估工具。
Objective To explore the clinical significance of WORSEN score in predicting early neurological deterioration(END) in acute Ischemic stroke(AIS) patients. Methods The clinical data of 402 patients with AIS were retrospectively collected from neurology department of one tertiary grade A hospital by convenient sampling method from January 2014 to December 2017. The first validation group(group 1) consisted of 300 patients from January 2014 to December 2016, and the second validation group(group 2)102 patients from January to December 2017. Patients were evaluated by using National Institutes of Health Stroke Scale(NIHSS)within 24 h of admission and the laboratory and imaging examination results were evaluated by using WORSEN score for admitted patients. The incidence of early neurological deterioration was recorded. According to the Receiver Operating Characteristic Curve(ROC), Area under the ROC Curve(AUC), Youden index, sensitivity and specificity, the value of WORSEN score in predicting END was assessed. Results WORSEN score was positively correlated with the incidence of END(r=0.424,P<0.001) and the higher the score, the greater probability of the END. The score of patients in the 2 groups fluctuated between 0 to 7 and when WORSEN score was 3, The Youden index was the best, which was the best cut-off point to predict the occurrence of END. In group 1, the AUC of the predicted END was 0.778(95%CI: 0.710~0.845), with a sensitivity of 68.0%, specificity of 76.8%, accuracy of 75.3%, positive predictive value of 37.0% and negative predictive value of 92.3%, and it had good fitting degree with group 2(χ~2=7.000, P=0.321). Conclusion WORSEN score has good prediction value for the occurrence of END, which can be used as an assessment tool for clinical medical staff to judge the progress of AIS patients.
作者
汪云云
谢小华
潘璐
张剑
邓丽萍
熊小云
马家惠
肖静怡
WANG Yun-yun;XIE Xiao-hua;PAN Lu;ZHANG Jian;DENG Li-ping;XIONG Xiao-yun;MA Jia-hui;XIAO Jing-yi(Anhui Medical University,Clinical College of the Second Shenzhen Hospital,Hefei 230032,China;The Second People’s Hospital of Shenzhen,the First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China;Guangzhou Medical University,Guangzhou 510000,China)
出处
《护理学报》
2019年第5期1-5,共5页
Journal of Nursing（China）
基金
广东省科学技术厅资助项目(2017A020215121)
广东省卫生经济学会项目(2017-WJ02-08)
深圳市第二人民医院临床研究项目(20173357201830)
深圳市科技创新委员会项目(CXZZ20140418182638768)
