摘要目的 建立高分级动脉瘤性蛛网膜下腔出血(aSAH)显微外科的术前风险评分,并评价该评分对预后预测的准确性.方法 回顾性纳入2010年10月至2014年4月国内10家医疗中心采用显微外科手术治疗的世界神经外科联合会分级(WFNS)4级或5级的aSAH患者119例,根据年龄、WFNS分级、有无脑疝、有无脑室积血行术前风险评分(0～5分).随访6～28(12.5±3.4)个月,采用改良Rankin量表评分(mRS)评估预后,将患者分为预后良好(mRS为0～3分)和预后不良(mRS为4～6分).采用受试者工作特征曲线(ROC)评价风险评分预测预后的准确性.结果 119例患者中,59例(49.6％)预后良好;60例(50.4％)预后不良,其中37例死亡(31.0％).术前风险评分不同者预后差异有统计学意义(x2=42.077,P＜0.01);其中术前评分≤1分者,预后不良的发生率为21.2％((11/52);术前评分≥4分者,预后不良的比例为8/9,术前评分越高,预后不良的发生率越高.该评分预测预后不良的曲线下面积=0.79(95％ CI:0.71 ～0.87,P＜0.01),术前评分为2分,提示预后不良的灵敏度为82％,特异度为70％,拟合优度良好(x2=2.388,P=0.496).结论 术前风险评分有助于预测显微外科手术治疗的aSAH患者的预后.

abstractsObjectives To develop a risk score before microsurgery for poor-grade aneurysmal subarachnoid hemorrhage (aSAH) and to evaluate the score for the accuracy of predicting prognosis.Methods A total of 119 patients with aSAH (World Federation of Neurosurgical Societies [WFNS] grade 4-5) treated with microsurgery in several medical centers in China from October 2010 to April 2014 were enrolled retrospectively.Preoperative risk scores (0-5 score) were conducted according to their age,WFNS score,having cerebral hernia or not,and having ventricle hematocele or not.They were followed up for 6-28 (12.5 ± 3.4) months.The modified Rankin scale (mRS) was used to evaluate the prognosis.The patients were divided into good prognosis (mRS 0-3) and poor prognosis (mRS 4-6).Receiver operating characteristic (ROC) curve was used to evaluate the risk score for the accuracy of predicting prognosis.Results Fifty-nine patients (49.6％) had good prognosis,60 (50.4％) had poor prognosis and 37 of them died (31.0％).There were significant prognosis differences in patients with different preoperative risk scores (x2 =42.077,P ＜ 0.01).In patients with preoperative score ≤ 1,the incidence of poor prognosis was 21.2％ (11/52);preoperative score ≥ 4,the proportion of poor prognosis was 8/9.The higher the preoperative score,the higher the incidence of poor prognosis.The area under the curve of this score predicting poor prognosis was 0.79 (95％ CI 0.71-0.87,P ＜0.01).If the preoperative score was 2,it suggested that the sensitivity of poor prognosis was 82％,the specificity was 70％,and the goodness of fit was good (x2 =2.388,P =0.496).Conclusion Preoperative risk score is helpful in predicting the prognosis of patients with aSAH who were treated with microsurgery.