神经功能缺损严重程度与发病后最初几小时的最终功能结局的关系发生改变和增强。
Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset.
机构信息
Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
出版信息
Stroke. 2012 Jun;43(6):1537-41. doi: 10.1161/STROKEAHA.111.636928. Epub 2012 Apr 5.
BACKGROUND AND PURPOSE
Early neurological deficit severity is the most important determinant of final functional outcome in acute ischemic stroke. However, deficit severity frequently changes during the first hours and days postonset.
METHODS
Analysis of control group patients enrolled in the 2 National Institute of Neurological Disorders and Stroke tissue-type plasminogen activator trials. Neurological deficit severity was measured serially using the National Institutes of Health Stroke Scale (NIHSS) at 1 to 3 hours postonset, 3 to 5 hours, 24 hours, 7 to 10 days, and 90 days. Final global disability outcome was assessed at 90 days using the modified Rankin Scale.
RESULTS
Among the 312 patients, median neurological deficit severity on the NIHSS improved throughout the 90-day observation period, from 15 (interquartile range, 9.5-20) at 1 to 3 hours, to 12 (interquartile range, 6-19) at 24 hours, to 7 (interquartile range, 2-19) at 90 days. Between 1-to-3-hours to 24 hours, more patients spontaneously improved than worsened: 39.1% versus 17.6% (P<0.001). NIHSS scores associated with individual final modified Rankin Scale global disability ranks shifted to lower values over time; eg, patients with a final modified Rankin Scale of 2 had the following median NIHSS scores: 12 at 1 to 3 hours, 10 at 3 to 5 hours, 9 at 24 hours, and 3 at 90 days. Correlation coefficients between NIHSS and the final modified Rankin Scale increased over time, from 0.51 at 1 to 3 hours, to 0.72 at 24 hours, to 0.87 at 90 days.
CONCLUSIONS
During the first 24 hours after onset, spontaneous improvement occurs in 2 of 5 acute ischemic stroke patients. The NIHSS scores associated with individual global disability ranks decrease over time. Neurological deficit severity increasingly predicts final disability outcome, accounting for one quarter of the variance at 1 to 3 hours, one half at 24 hours, and three quarters at 90 days.
背景与目的
急性缺血性脑卒中发病后最初数小时至数天内，神经功能缺损严重程度是决定最终功能结局的最重要因素。然而，发病后最初数小时至数天内，神经功能缺损严重程度常常发生变化。
方法
对 2 项美国国立卫生研究院卒中量表（NIHSS）组织型纤溶酶原激活物溶栓临床试验的对照组患者进行分析。发病后 1 至 3 小时、3 至 5 小时、24 小时、7 至 10 天和 90 天，使用 NIHSS 连续测量神经功能缺损严重程度。发病 90 天，采用改良 Rankin 量表评估最终总体残疾结局。
结果
312 例患者中，发病 90 天内 NIHSS 中位数逐渐改善，从发病后 1 至 3 小时的 15（四分位间距 9.5-20），到 24 小时的 12（四分位间距 6-19），到 90 天的 7（四分位间距 2-19）。发病后 1 至 3 小时至 24 小时，自发改善患者多于恶化患者：39.1%比 17.6%（P<0.001）。随着时间推移，与个体最终改良 Rankin 量表总体残疾等级相关的 NIHSS 评分向较低值转移；例如，最终改良 Rankin 量表为 2 分的患者 NIHSS 评分中位数如下：发病后 1 至 3 小时为 12，发病后 3 至 5 小时为 10，发病后 24 小时为 9，发病后 90 天为 3。发病后 1 至 3 小时至 90 天，NIHSS 与最终改良 Rankin 量表之间的相关系数逐渐增加，从 0.51 增加至 0.72，再增加至 0.87。
结论
发病后最初 24 小时内，2/5 的急性缺血性脑卒中患者自发改善。与个体总体残疾等级相关的 NIHSS 评分随时间推移逐渐降低。神经功能缺损严重程度逐渐预测最终残疾结局，在发病后 1 至 3 小时占方差的四分之一，发病后 24 小时占一半，发病后 90 天占四分之三。
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