摘要
目的探讨入院时NIHSS评分对幕上自发性脑出血早期血肿扩大的预测价值。方法回顾性系列分析86例幕上自发性脑出血患者的临床资料,患者分别于发病6 h内及24~48 h行头颅CT检查,定义血肿扩大为血肿体积增加≥33%或≥12.5 mL。将单因素分析显示血肿扩大的相关因素纳入多因素回归分析,确定血肿扩大的独立相关因素。应用ROC曲线确定NIHSS评分预测血肿扩大的价值。结果血肿扩大的发生率为16.3%（14/86）。单因素分析显示初次CT血肿体积、入院时高NIHSS评分、高收缩压和高舒张压为早期血肿扩大的相关因素。多因素回归分析表明入院时NIHSS（OR 1.355[95%CI1.050-1.748],P=0.020）和收缩压水平（OR 1.061[95%CI 1.004-1.122],P=0.036）是血肿扩大的独立预测因素。NIHSS预测血肿扩大的ROC曲线下面积为为0.817（95%CI 0.701-0.934）,NIHSS≥6分时敏感性及特异性分别为85.7%和66.7%,而NIHSS≥11分时敏感性及特异性为57.1%和94.4%。结论 NIHSS可作为预测脑出血后早期血肿扩大的工具之一,NIHSS≥6时患者出现血肿扩大的风险加大。
Objective To determine whether the National Institutes of Health Stroke Scale（NIHSS） score is associated with early hematoma expansion（HE） in patients with supratentorial intracerebral hemorrhage（SIL）.Methods The clinical data of SIL 86 patients were retrospectively reviewed in the study.All patients underwent cranial CT scan within 6 hours of symptom onset and a repeat computed tomography within 24-48 hours.Significant HE was defined as hematoma enlargement ≥33% or ≥12.5 mL according to CT images.Clinical features were compared between patients with or without HE.Multivariable logistic regression was applied to confirm the independent indicators of HE.The predictive value of NIHSS score in HE was evaluated with receiver-operating characteristic（ROC） curve.Results HE occurred in 14 patients（16.3%）.On simple analysis,the predictors of HE were large baseline hematoma volume,high NIHSS score and high systolic/diastolic BP level on admission.Multiple logistic regression analysis showed that HE was associated with worsening of NIHSS score（OR 1.355 [95% CI 1.050-1.748],P=0.020） and high SBP level（OR 1.061 [95% CI 1.004-1.122],P=0.036）.On ROC analysis,the score demonstrated good performance to indicate HE with an area under the curve of 0.817（95%CI 0.701-0.934）.With NIHSS ≥6,the sensitivity and specificity could reach 85.7% and 66.7% to predict HE.Given a score ≥11,the sensitivity（57.1%） suffered at high specificity（94.4%）.Conclusion NIHSS assessment may be a useful approach to predict early HE.Those with scores of 6 or more will have high risk of HE.
出处
《实用临床医药杂志》
CAS
2012年第15期27-31,共5页
Journal of Clinical Medicine in Practice
关键词
脑出血
血肿扩大
美国国立卫生研究院卒中量表
intracerebral hemorrhage
hematoma expansion
National Institutes of Health Stroke Scale
