本文選題：蛛網(wǎng)膜下腔出血 + WFNS分級(jí)系統(tǒng)　； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:在第十五屆世界神經(jīng)外科大會(huì)上,Sano等人提出了世界神經(jīng)外科聯(lián)盟分級(jí)系統(tǒng)的修改版本(modified World Federation of Neurological Societies Scale,m-WFNSS)。本研究旨在對(duì)比新舊版本W(wǎng)FNS分級(jí)系統(tǒng)在動(dòng)脈瘤性蛛網(wǎng)膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者預(yù)后評(píng)估方面的臨床價(jià)值。方法:收集2009年1月至2015年1月在蘇州大學(xué)附屬第二醫(yī)院神經(jīng)外科住院,且患病后72小時(shí)內(nèi)行手術(shù)治療的a SAH患者臨床資料269例,記錄患者年齡、性別、入院時(shí)的GCS評(píng)分、體格檢查(是否存在偏癱或失語)、并發(fā)癥及手術(shù)方式等結(jié)果。患者出院時(shí),用格拉斯哥轉(zhuǎn)歸量表(Glasgow Outcome Scale,GOS)評(píng)價(jià)預(yù)后。將登記的患者分為預(yù)后不良和預(yù)后良好兩個(gè)亞組,GOS中的死亡、植物生存狀態(tài)(Vegetable State,VS)、嚴(yán)重殘疾定義為預(yù)后不良,輕度殘疾及康復(fù)良好定義為預(yù)后良好。用曼-惠特尼u檢驗(yàn)(Mann-whitney u test)和χ2檢驗(yàn)比較原版世界神經(jīng)外科聯(lián)盟分級(jí)系統(tǒng)(original World Federation of Neurological Societies Scale,o-WFNSS)和m-WFNSS內(nèi)部相鄰分級(jí)水平之間的患者在預(yù)后方面是否存在統(tǒng)計(jì)學(xué)差異;預(yù)后相關(guān)性分析用spearman檢驗(yàn)和logistic回歸分析;用接收者操作特征(Receiver Operator Characteristic,ROC)曲線比較o-WFNSS和m-WFNSS評(píng)估a SAH患者預(yù)后的準(zhǔn)確性。結(jié)果:在m-WFNSS任何相鄰分級(jí)水平之間,患者GOS平均值均有顯著的統(tǒng)計(jì)學(xué)差異(P0.05),而o-WFNSS中Ⅱ級(jí)和Ⅲ級(jí)之間的GOS平均值沒有顯著的統(tǒng)計(jì)學(xué)差異(P=0.418);在m-WFNSS中,除了Ⅲ級(jí)和Ⅳ級(jí)外,其余相鄰等級(jí)之間的患者預(yù)后分布均有顯著的統(tǒng)計(jì)學(xué)差異(P0.05),而o-WFNSS的Ⅱ級(jí)和Ⅲ級(jí)、Ⅲ級(jí)和Ⅳ級(jí)之間的患者預(yù)后分布無明顯的統(tǒng)計(jì)學(xué)差異(P0.05);Spearman檢驗(yàn)和logistic回歸分析證明WFNS分級(jí)系統(tǒng)與患者預(yù)后呈顯著負(fù)相關(guān),但m-WFNSS內(nèi)部各分級(jí)水平的OR值上升趨勢較o-WFNSS明顯;ROC曲線分析表明,m-WFNSS和o-WFNSS對(duì)患者預(yù)后的預(yù)測均具有較高的準(zhǔn)確性(P0.0001),兩者的曲線下面積(Area Under Curve,AUC)分別為0.812、0.807。結(jié)論:雖然m-WFNSS仍需進(jìn)一步改進(jìn),但對(duì)于神經(jīng)外科醫(yī)生,m-WFNSS評(píng)估a SAH患者預(yù)后比o-WFNSS更簡單、可靠。
[Abstract]:Objective: at the 15th World Congress of Neurosurgery, Sano et al proposed a modified version of the classification system of the World Federation of Neurosurgery. The purpose of this study was to evaluate the prognosis of patients with aneurysm subarachnoid hemorrhage (SAH) by using the new and old WFNS classification system. Methods: from January 2009 to January 2015, 269 patients with a SAH who were hospitalized in neurosurgery department of the second affiliated Hospital of Suzhou University and operated within 72 hours after the disease were collected. The age, sex and GCS score of the patients were recorded. Physical examination (presence of hemiplegia or aphasia, complications and surgical procedures, etc. On discharge, Glasgow Outcome scale was used to evaluate the prognosis. The registered patients were divided into two subgroups of poor prognosis and good prognosis: death in GOS, vegetative state of vegetative state, severe disability as poor prognosis, mild disability and good rehabilitation as good prognosis. Mann-Whitney u test (Mann-Whitney u test) and 蠂 2 test were used to compare the prognosis of patients with the original World Federation of Neurological Societies Scaleo-WFNSSSS and the adjacent grading levels within m-WFNSS. The prognostic correlation analysis was performed by spearman test and logistic regression analysis, and the accuracy of o-WFNSS and m-WFNSS in evaluating the prognosis of patients with a SAH was compared with the receiver Operator characteristic curve. Results: there was significant statistical difference in the mean value of GOS between any adjacent grades of m-WFNSS (P 0.05), but there was no significant difference in the mean value of GOS between grade 鈪，

本文編號(hào)：1957438