e-NIHSS量表联合HINTS检查对前庭症状为主的后循环缺血的评估探讨  

Evaluation of e-NIHSS scale combined with HINTS for posterior circulation ischemic stroke with vestibular symptoms

作　　者：陈泽雯 付蓉 赵晶 黄名璐 高丽娜 刘娟 CHEN Zewen;FU Rong;ZHAO Jing;HUANG Minglu;GAO Lina;LIU Juan(Department of Neurology,Guiyang Second People's Hospital,Guiyang,550081,China)

机构地区：[1]贵阳市第二人民医院神经内科,贵阳550081

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第10期947-950,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的探讨HINTS床旁检查法及e-NIHSS量表对前庭症状为主的后循环缺血的预测价值。方法选取2021年4月-2023年4月在贵阳市第二人民医院神经内科住院的急性前庭综合征(acute vestibular syndrome,AVS)患者136例为研究对象,依据AVS病因分类,将68例中枢性AVS患者即后循环缺血(posterior circulation ischemia,PCI)为病例组,68例周围性AVS患者作为对照组,收集资料并床旁行头脉冲-眼震-眼偏斜试验,2名医师分别对以前庭症状为主的PCI患者进行NIHSS及e-NIHSS量表评估,结果取得一致后进行记录,并完善头颅MRI检查。结果头脉冲试验在以前庭症状为主的PCI患者阳性率为3例(4.41%),外周性60例(88.24%);眼震试验在PCI组患者中阳性率64例(94.12%),外周性21例(30.88%);眼偏斜试验在PCI组患者中阳性率55例(80.88%),外周性8例(11.76%),并将资料与最终确诊一致性比较,灵敏度为97.0%,特异度为95.7%,准确性0.963,通过Kappa一致性检验(κ=0.926,P<0.01)。对PCI组患者进行评分,其中脑干组NIHSS评分1.51±0.59,e-NIHSS评分4.05±1.71(P<0.05);小脑组NIHSS评分1.42±0.62,e-NIHSS评分3.86±1.59(P<0.05);丘脑组NIHSS评分1.31±0.73,e-NIHSS评分3.56±1.27(P<0.05);无病灶组NIHSS评分1.11±0.43,e-NIHSS评分3.06±1.20,(P<0.01)。e-NIHSS量表与NIHSS量表在各组比较中差异有统计学意义(P<0.05)。结论HINTS检查与金标准的最终诊断有高度的一致性,e-NIHSS评分量表较NIHSS评分量表对以前庭症状为主的后循环缺血患者有更高的检出率。Objective To explore the predictive value of HINTS bedside examination and e-NIHSS scale for posterior circulation ischemia with vestibular symptoms.Methods 136 cases in total patients with acute vestibular syndrome(AVS)hospitalized in our hospital from April 2021 to April 2023 were selected as the study subjects,According to the classification of AVS etiology,patients with central AVS,namely posterior circulation ischemia(PCI),were divided into case group(68 cases)and peripheral AVS patients were control group(68 cases),Collect data and perform head impulse test-nystagmus-test of skew deviation test beside the bed,two doctors evaluated the NIHSS and e-NIHSS scales for PCI patients with vestibular symptoms respecb tively,and recorded the results after they were consistent,and improved the head MRI examination.Results The positive rate of head pulse test in PCI patients with vestibular symptoms was 3 cases(4.41%),and 60 cases(88.24%)with peripheral symptoms;The positive rate of nystagmus test in PCI group was 64 cases(94.12%)and peripheral 21 cases(30.88%);The positive rate of eye deviation test in PCI group was 55 cases(80.88%)and peripheral 8 cases(11.76%).Comparing the data with the consistency of the final diagnosis,the sensitivity was 97.0%,the specificity was 95.7%,and the accuracy was 0.963.It passed the Kappa consistency test Kappa=0.926(P<0.01).The patients in PCI group were scored,in which the NIHSS score of brainstem group was 1.51±0.59,and the e-NIHSS score was 4.05±1.71(P<0.05);The NIHSS score of cerebellar group was 1.42±0.62,and the e-NIHSS score was 3.86±1.59(P<0.05);NIHSS score of thalamus group was 1.31±0.73,e-NIHSS score was 3.56±1.27(P<0.05);NIHSS score of non-focus group was 1.11±0.43,e-NIHSS score was 3.06±1.20(P<0.01).The difference between e-NIHSS score and NIHSS score in each group was statistically significant.Conclusion HINTS examination is highly consistent with the final diagnosis of the gold standard.The e-NIHSS scoring scale has a higher detection rate than the NIHSS scoring

关 键 词：后循环缺血 急性前庭综合征 头脉冲-眼震-眼偏斜试验 凝视诱发眼震 

分 类 号：R764.34[医药卫生—耳鼻咽喉科]