全面无反应量表在重症动脉瘤性蛛网膜下腔出血预后评估中的应用

doi:10.3969/j.issn.1006-7795.2018.01.006

摘要/Abstract

摘要： 目的探究全面无反应量表（Full Outline of Unresponsiveness Scale，FOUR）在重症动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）预后评估中的应用价值。方法本研究属于前瞻性、观察性队列研究；以世界神经外科医师联盟（World Federation of Neurosurgical Societies，WFNS）分级 ≥ Ⅳ级的重症aSAH患者为研究对象，在其完成手术或介入治疗并转入重症监护病房（intensive care unit，ICU）后对其进行同步的FOUR评分和格拉斯哥昏迷评分（Glasgow Coma Scale，GCS）；预后随访定于术后3个月，以改良的Rankin评分（Modified Rankin Scale，mRS）≥ 4分为不良预后；统计方法包括单因素分析及多因素Logistic回归分析，并绘制FOUR与GCS评分预测不良预后的受试者工作特征（receiver operating characteristic，ROC）曲线计算曲线下面积（area under curves，AUC），同时通过敏感度（sensitivity，SEN）、特异度（specificity，SPE）、阳性预测值（positive predictive value，PPV）和阴性预测值（negative predictive value，NPV）评价相关预测指标。结果共34例患者被纳入研究，分析结果显示仅FOUR量表是与不良预后显著相关的独立危险因素（OR=0.22，95% CI：0.01~0.75，P<0.05），而且该指标预测不良预后的辨别力（AUC=0.87，SEN=0.91，SPE=0.85，PPV=0.88，NPV=0.84）等均要好于GCS评分（AUC=0.79，SEN=0.71，SPE=0.79，PPV=0.79，NPV=0.69）。结论与GCS评分相比，FOUR量表能够更加准确地预测重症aSAH术后的远期转归。

关键词: 动脉瘤性蛛网膜下腔出血, 重症, 全面无反应量表, 格拉斯哥昏迷评分, 预后

Abstract: Objective To explore the value of the Full Outline of Unresponsiveness Scale (FOUR) in the outcome prediction of severe aneurysmal subarachnoid hemorrhage (aSAH).Methods This is a prospective, observational cohort study. Patients who were diagnosed as aSAH with a World Federation of Neurosurgical Societies (WFNS) grade of Ⅳ or Ⅴ were consecutively included after aggressive treatment,and they were transferred to our intensive care unit for evaluation by FOUR and Glasgow Coma Scale (GCS). The follow-up was performed at 3 months after SAH ictus, based on the Modified Rankin Scale (mRS). The univariate analysis and multivariate logistic regression were applied for statistical evaluation. The receiver operating characteristic curves for the outcome prediction of FOUR and GCS scores were drawn, with area under curves (AUC) calculated, in the meanwhile, their sensitivity (SEN), specificity (SPE), positive predictive values (PPV), and negative predictive values (NPV) were assessed.Results A total of 34 patients were enrolled. Only FOUR scores were identified to be the independent risk factor for poor outcome (mRS4 to 6) (odds ratio 0.22 95% confidence interval 0.01-0.75,P<0.05). Moreover, its Scores (AUC=0.87, SEN=0.91, SPE=0.85, PPV=0.88, NPV=0.84) were all better than those of GCS scores (AUC 0.79, SEN 0.71, SPE 0.79, PPV 0.79, NPV 0.69, respectively).Conclusion In comparison with GCS scores, FOUR scale performs better in the postoperative outcome prediction in severe aSAH.

Key words: aneurysmal subarachnoid hemorrhage, critical illness, Full Outline of Unresponsiveness Scale, Glasgow Coma Scale, prognosis

中图分类号:

R743.35

赵经纬, 罗旭颖, 徐明, 石广志, 周建新. 全面无反应量表在重症动脉瘤性蛛网膜下腔出血预后评估中的应用[J]. 首都医科大学学报, 2018, 39(1): 28-34.

Zhao Jingwei, Luo Xuying, Xu Ming, Shi Guangzhi, Zhou Jianxin. Outcome prediction in severe aneurysmal subarachnoid hemorrhage utilizing the Full Outline of Unresponsiveness Scale[J]. Journal of Capital Medical University, 2018, 39(1): 28-34.

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