Rosen David S, Macdonald R Loch
Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL 60637, USA.
Neurocrit Care. 2005;2(2):110-8. doi: 10.1385/NCC:2:2:110.
Numerous systems are reported for grading the clinical condition of patients following subarachnoid hemorrhage (SAH). The literature was reviewed for articles pertaining to the grading of such patients, including publications on the Hunt and Hess Scale, Fisher Scale, Glasgow Coma Score (GCS), and World Federation of Neurological Surgeons Scale. This article reviews the advantages and limitations of these scales as well as more recent proposals for other grading systems based on these scales with or without addition of other factors known to be prognostic for outcome after SAH. There remain substantial deficits in the literature regarding grading of patients with SAH. Most grading scales were derived retrospectively, and the intra- and interobserver variability has seldom been assessed. Inclusion of additional factors increases the complexity of the scale, possibly making it less likely to be adopted for routine usage and increasing (only marginally in some cases) the ability to predict prognosis. Until further data are available, it is recommended that publications on patients with SAH report at least the admission GCS as well as factors commonly known to influence prognosis, such as age, pre-existing hypertension, the amount of blood present on admission computed tomography, time of admission after SAH, aneurysm location and size, presence of intracerebral or intraventricular hemorrhage, and blood pressure at admission.
有许多系统被报道用于对蛛网膜下腔出血（SAH）后患者的临床状况进行分级。我们对文献进行了回顾，以查找与此类患者分级相关的文章，包括关于Hunt和Hess量表、Fisher量表、格拉斯哥昏迷评分（GCS）以及世界神经外科医师联盟量表的出版物。本文回顾了这些量表的优点和局限性，以及基于这些量表的其他分级系统的最新提议，这些提议有的添加了其他已知对SAH后预后有预后价值的因素，有的则没有。关于SAH患者分级的文献仍存在重大缺陷。大多数分级量表是回顾性得出的，观察者内和观察者间的变异性很少被评估。纳入额外因素会增加量表的复杂性，可能使其不太可能被用于常规用途，并且（在某些情况下只是略有增加）增加预测预后的能力。在获得更多数据之前，建议关于SAH患者的出版物至少报告入院时的GCS以及通常已知会影响预后的因素，如年龄、既往高血压、入院计算机断层扫描上的出血量、SAH后的入院时间、动脉瘤位置和大小、脑内或脑室内出血的存在以及入院时的血压。
