Department of Neurological Surgery, Tri Service General Hospital, Taiwan, China.
Neurol India. 2012 Nov-Dec;60(6):608-12. doi: 10.4103/0028-3886.105195.
Decompressive hemicraniectomy is accepted as the most effective life-saving treatment for malignant middle cerebral artery (MCA) infarction. However, the outcome remains hard to predict. This study examined the efficacy of using the Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores before emergency craniectomy for predicting clinical outcome in malignant MCA infarction.
Seventy-nine consecutive patients with malignant MCA infarction treated from January 2006 to October 2010 were retrospectively analyzed. The GCS and APACHE II scores within the first 24 h of neurological deterioration or before decompressive hemicraniectomy, were used to predict short-term functional outcome rated by the modified Rankin Scale (mRS). The receiver operating characteristic (ROC) curve was obtained to determine the accuracy and best cut-off value for each scoring system.
At 6 months, there was dramatic life-saving effect of surgery, with a significant reduction in mortality rate (from 71% to 19%, P < 0.001). After the ROC analysis, cut-off values of pre-operative GCS > 8 (P = 0.003) and APACHE II <13 (P = 0.006) were sufficiently sensitive and specific to predict favorable outcome (mRS 0-3).
Pre-operative GCS and APACHE II scores are useful tools in predicting outcomes for patients with malignant MCA infarction who underwent decompressive hemicraniectomy.
去骨瓣减压术被认为是治疗恶性大脑中动脉（MCA）梗死最有效的救生治疗方法。然而，其预后仍然难以预测。本研究探讨了在紧急去骨瓣减压术前使用格拉斯哥昏迷评分（GCS）和急性生理学与慢性健康评估（APACHE）Ⅱ评分预测恶性 MCA 梗死患者临床预后的疗效。
回顾性分析了 2006 年 1 月至 2010 年 10 月期间连续收治的 79 例恶性 MCA 梗死患者。使用神经恶化或去骨瓣减压术前 24 小时内的 GCS 和 APACHE II 评分预测改良 Rankin 量表（mRS）评分的短期功能预后。获得受试者工作特征（ROC）曲线以确定每个评分系统的准确性和最佳截断值。
6 个月时，手术具有显著的救生效果，死亡率显著降低（从 71%降至 19%，P<0.001）。经过 ROC 分析，术前 GCS>8（P=0.003）和 APACHE II<13（P=0.006）的截断值具有足够的敏感性和特异性，可以预测良好的预后（mRS 0-3）。
术前 GCS 和 APACHE II 评分是预测行去骨瓣减压术的恶性 MCA 梗死患者预后的有用工具。
