卒中常用量表课件

1,/46,Ward 3,Neurology&Neurosurgery,神经科 卒中常用量表,Neurology,&,Neurosurgery Ward,3,第四五四医院神经内科,焦冬生,2019,Dec 15,神经科 卒中常用量表Neurology&Neuros,量化：利于病情评估及病情的比较,分层：选择特定治疗方案和评估预后,统一标准：便于医师间的交流和科学研究（纳入病人时可通过评分保持不同组间基线水平一致）,现代医学的重要标志就是量化，将经验描述更改为定量描述是医学的进步,量表成为不同中心对话的公共语言，更是临床科研的必备工具,神经系统疾病临床表现复杂，熟练掌握各种量表是对神经科医生的基本要求,为什么需要量表？,量化：利于病情评估及病情的比较现代医学的重要标志就是量化，将,2,中国卒中量表（,2019,）（,China Stroke Scale,，,CSS,）,美国国立卫生研究院卒中量表（,1989/1994/2019,）（,The National Institutes of Health Stroke Scale,，,NIHSS,）,格拉斯哥昏迷评分（,1974,）（,Glasgow Coma Scale,，,GCS,）,改良,Rankin,量表,（,20,世纪,50,年代）（,Modified Rankin Scale,，,mRS,）,改良,Barthel,指数（,1965,）（,Modified Barthel Index,，,MBI,）,眼睑水肿或面部骨折病人睁眼反应无法测，用,C(,闭眼,/Closed),代替评分。如,ECV5M6,言语障碍病人言语反应无法测，用,D(,言语障碍,/dysphasia),或,a(,失语,/aphasia),代替评分。如,E4VDM6,、,E4VaM6,气管切开或气管插管病人言语反应无法测，用,T(,气管切开,/Tracheotomy,或气管插管,/Tracheal intubation),代替评分。如,E4VTM6,如果两次刺激后患者的反应不同，或者两侧肢体反应不同，按其最好反应评分,神经科卒中常用量表,中国卒中量表（2019）（China Stroke Scal,3,分类,经典量表,评定层次,临床意义,对病人,对医生,残损（器官水平）,Impairment,NIHSS,神经系统功能,+,+,残疾（个体水平）,Disability,Bathel,指数,日常生活能力,ADL,+,+,残障（社会水平）,Handicap,改良,Rankin,评分,mRS,回归社会能力,+,+,脑卒中临床评定量表的基本模式和分类,分类经典量表评定层次临床意义对病人对医生残损（器官水平）Im,4,0-42,分,兼顾前循环和后循环，涉及每个,主要,脑动脉的供血区域检查,客观的半定量脑卒中严重程度的评价工具,国际多中心随机对照研究广泛应用（,NINDS/rt-PA,）,具有较好的可重复性（评定者间信度和重测信度）,评分时间,5-10min,神经科医生、神经科护士、急诊医生均可评,NIHSS,概述,0-42分NIHSS概述,5,nihstrokescale.org/,nihstrokescale.org/,6,Toronto Stroke Scale,Oxbury,Initial Severity Scale,Cincinnati Stroke Scale,NIHSS,之前的量表,原始版,现行版,修订版,(,mNIHSS,),大陆中文版,台湾中文版,NIHSS,的版本,NIHSS,的历史,Toronto Stroke ScaleOxburyIn,7,l.a.,Level of,Consciousness,Alert,Drowsy,Stuporous,Coma,0,1,2,3,8.Plantar Reflex,Normal,Equivocal,Extensor,Bilateral extensor,0,1,2,3,l.b.LOC,Questions,Answers both correctly,Answers one correctly,Incorrect,0,1,2,9.Limb Ataxia,Absent,Present in upper or lower Present in both,0,1,2,1.c.LOC,Commands,Obeys both correctly,Obeys one correctly,Incorrect,0,1,2,10.Sensory,Normal,Partial loss,Dense loss,0,1,2,2.Pupillary,Response,Both reactive,One reactive,Neither reactive,0,1,2,11.Neglect,No neglect,Partial neglect,Complete neglect,0,1,2,3.Best Gaze,Normal,Partial gaze palsy Forced deviation,0,1 2,12.Dysarthria,Normal articulation Mild to moderate dysarthria,Near unintelligible or worse,0,1,2,4.Best Visual,No visual loss,Partial hemianopia,Complete hemianopia,0 1,2,5.Facial Palsy,Normal,Minor,Partial,Complete,0,1,2,3,13.Best,Language,No aphasia,Mild to moderate aphasia,Severe aphasia,Mute,0 1,2,3,6.Best Motor,Arm,NO drift,Drift,Cant resist gravity,No effort against gravity,0,1,2,3,14.Change from,Previous,Exam,Same,Better,Worse,S,B,W,7.Best Motor Leg,NO drift,Drift,Cant resist gravity,No effort against gravity,0,1 2 3,15.Change from Baseline,Same,Better,Worse,S,B,W,Stroke 1989;20:864-870,NIHSS,原始版,l.a.Level of Alert,8,1a Level of consciousness,0=Alert,1=Not alert,arousable,2=Not alert,obtunded,3=Unresponsive,3 Visual fields,0=No visual loss,1=Partial hemianopsia,2=Complete hemianopsia,3=Bilateral hemianopsia,6a Left motor leg,0=No drift,1=Drift before 5 s,2=Falls before 5 s,3=No effort against gravity 4=No movement,9 Language,0=Normal,1=Mild aphasia,2=Severe aphasia,3=Mute or global aphasia,1b Questions,0=Answers both correctly,1=Answers one correctly,2=Answers neither correctly,4 Facial palsy,0=Normal,1=Minor paralysis,2=Partial paralysis,3=Complete paralysis,6b Right motor leg,0=No drift,1=Drift before 5 s,2=Falls before 5 s,3=No effort against gravity 4=No movement,10 Dysarthria,0=Normal,1=Mild,2=Severe,1c Commands,0=Performs both tasks,correctly,1=Performs one task,correctly,2=Performs neither task,5a Left motor arm,0=No drift,1=Drift before 10 s,2=Falls before 10 s,3=No effort against gravity 4=No movement,7 Ataxia,0=Absent,1=One limb,2=Two limbs,11 Extinction/inattention,0=Normal,1=Mild,2=Severe,2 Gaze,0=Normal,1=Partial gaze palsy,2=Total gaze palsy,5b Right motor arm,0=No drift,1=Drift before 10 s,2=Falls before 10 s,3=No effort against gravity 4=No movement,8 Sensory,0=Normal,1=Mild loss,2=Severe loss,Lancet Neurol 2019;5:60312,NIHSS,现行版,1a Level of consciousness3 Vis,9,ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf,NIHSS,现行英文完整版,ninds.nih.gov/doctors/NIH_Stro,10,项目,评分标准,评分,1a,意识水平,0=,清醒，反应灵敏,1=,嗜睡，最小刺激可唤醒，可回答问题,2=,昏睡，强烈刺激可唤醒，反应迟钝,3=,昏迷，软瘫。仅有反射活动或无反应,1b,两项提问,(,年龄、月份,),0=,均回答正确,1=,正确回答一项,2=,两项回答均不正确,1c,两项指令,(,睁眼、伸手、握拳,),0=,均回答正确,1=,正确完成一项,2=,两项均不正确,2,凝视,0=,正常,1=,部分凝视麻痹,2=,完全凝视麻痹,3,视野,0=,无缺失,1=,象限盲、部分偏盲有明显,边界,2,=,完全偏盲,3=,双侧偏盲,4,面瘫,0=,正常,1=,轻度（轻微）,2=,中度（部分）,3=,重度（完全）,5,上肢运动,0,上肢要求位置坚持,10,秒，无下落,1,上肢能抬起，但不能维持,10,秒，下落时不撞击床或其他支持物,2,能对抗一些重力，但上肢不能达到或维持坐位,90,或位卧,45,，较快下落到床上,3,不能抗重力，上肢快速下落,4,无运动,9,截肢或关节融合,右,左,6,下肢运动,0,于要求位置坚持,5,秒，不下降,1,在,5,秒未下落，不撞击床,2,5,秒内较快下落到床上，但可抗重力,3,快速落下，不能抗重力,4,无运功,9,截肢或关节融合,右,左,7,共济失调,0=,正常,1=,一个肢体共济失调,2=,两个肢体共济失调,9,截肢或关节融合,8,感觉障碍,0=,正常,1=,痛觉减退,2=,痛觉缺失、触觉缺失,9,语言障碍,0=,正常,1=,轻到中度的言语表达和理解障碍,2=,重度的言语表达和理解障碍,3=,完全性失语,10,构音障碍,0=,正常,1=,构音不清,2=,言语含糊，不能被理解,9=,气管插管或其它物理障碍,11,忽视症,0=,正常,1=,视、触、听、空间觉忽视,2=,严重偏身忽视或超过一种形式的偏身忽视；不认识自己的手,翻译,指导语,特殊状况,理解差异,漏项,我就纳闷了,，,同样,是工作在一起的俩医生,，,评出来的分咋就相差这么多呢,？,NIHSS,中文版,项目评分标准评分1a意识水平0=清醒，反应灵敏1=嗜睡，