修订版美国国立卫生研究院卒中量表评估幕上占位患者镇静相关局部神经功能缺陷的诊断价值

Diagnostic value of the modified National Institutes of Health Stroke Scale in evaluating sedation-related focal neurological deficits for patients with supratentorial mass lesions

目的观察修订版美国国立卫生研究院卒中量表(modified National Institutes of Health Stroke Scale,mNIHSS)在评估幕上占位患者的镇静相关局部神经功能缺陷时,对其诊断性指标的影响。方法研究纳入既往通过美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)行轻度镇静后神经功能评估的幕上占位患者,对镇静诱发的NIHSS变化阳性(NIHSS改变≥2分)及阴性(NIHSS改变<2分)患者使用mNIHSS进行重新评估,以NIHSS改变的结果为标准,评价mNIHSS对检测幕上占位患者镇静诱发局部神经功能缺陷的诊断价值。结果使用NIHSS评估发现:与镇静前比较,丙泊酚和咪达唑仑镇静后肢体运动和肢体共济两项神经功能评分明显升高,芬太尼和右美托咪定镇静后肢体运动评分明显升高,差异有统计学意义(P<0.05)。NIHSS评分为阴性的患者其mNIHSS均为阴性;54例NIHSS评分为阳性的患者中有51例患者mNIHSS评分为阳性,3例患者mNIHSS评分为阴性。使用mNIHSS评估幕上占位患者镇静诱发神经功能缺陷的敏感度为94.44%,特异性为100%,漏诊率为5.56%,误诊率为0,约登指数为0.944,Kappa=0.95。结论mNIHSS简便易行,用于评估幕上占位患者的镇静相关神经功能改变的敏感度和特异性高,且与NIHSS的评估一致性较高,但存在一定的漏诊率。

Objective To observe the diagnostic value of the modified National Institutes of Health Stroke Scale(mNIHSS)in evaluating sedation-related focal neurological deficits for patients with supratentorial mass lesions.Methods Mild sedation related focal neurological deficits in patients with supratentorial mass lesions who were evaluated by National Institutes of Health Stroke Scale(NIHSS)were retrospectively enrolled.Both sedative-induced positive change(NIHSS score change≥2)and negative change(NIHSS score change<2)patients were re-evaluated by mNIHSS,and their diagnostic values were evaluated based on the results of NIHSS in the same population.Results NIHSS evaluation showed that after sedation,the neurological function scores of limb motor and limb ataxia were significantly increased after propofol and midazolam,and the limb motor scores were significantly increased after fentanyl and dexmedetomidine,with statistical significance(P<0.05).All NIHSS negative change patients were negative when evaluated by mNIHSS.For those having NIHSS positive changes,51 out of 54 patients presented positive changes in mNIHSS evaluation and 3 out of 54 patients presented negative changes in mNIHSS.For supratentorial mass lesion patients,the sensitivity of mNIHSS tested sedative-induced neurological deficits was 94.44%,the specificity was 100%,the rate of missed diagnosis was 5.56%and the misdiagnosis rate was 0.The Youden index was 0.944 and Kappa score was 0.95.Conclusions mNIHSS is an easy and reliable method in evaluating neurological function for supratentorial mass lesion patients when conducting sedation related neurological deficits researches,which showed a high sensitivity and specificity as well as good consistence with NIHSS.