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目的本研究旨在于编制椎-基底动脉系统急性缺血性脑血管病溶栓干预风险-效益评价量表,以期预测溶栓干预的风险和收益,从而达到指导临床溶栓决策和提高溶栓疗效的目的。方法本研究以2003年2月-2008年12月间宣武医院卒中中心收治的98例椎-基底动脉系统急性缺血性脑血管病溶栓患者为研究对象,采用评分者信度、准则关联效度,以及受试者工作特征曲线(ROC)等方法对量表的信度、效度、临床预测价值进行检测分析。结果信度检测结果提示,量表的总评分和分项评分均显示较高的α信度系数。以患者溶栓干预后30天mRS评分改善≤2作为溶栓干预有效性的评价准则,对不同溶栓干预预后患者的基线风险-效益量表评分进行显著性检测分析提示,溶栓后改善组、无改善组、恶化组之间有十分显著的统计学差异(P<0.01)。POSThoc分析提示,以35分和45分分别作为溶栓干预“良好预后”和“不良预后”预测界点显示较好的预测效果,ROC曲线下面积分别为0.824和0.873。结论在本研究的平台上,椎-基底动脉系统急性缺血性脑血管病溶栓干预的风险-效益评价量表显示较好的信度、效度、临床应用价值和经济学价值,有望成为一种新的用于预测溶栓治疗风险和收益,指导临床溶栓干预决策的简便、有效评价工具。
Purpose This study was designed to prepare a risk-benefit assessment scale for thrombolytic intervention in patients with acute ischemic cerebrovascular disease of the vertebrobasilar system in order to predict the risks and benefits of thrombolytic intervention so as to guide clinical thrombolysis decisions and improve thrombolytic efficacy the goal of. Methods In this study, 98 patients with thrombolytic therapy of acute ischemic cerebrovascular disease of vertebrobasilar system admitted to Xuanwu Hospital Stroke Center from February 2003 to December 2008 were selected as research objects. Degree, and receiver operating characteristic curve (ROC) and other methods to measure the reliability, validity, clinical prediction value of the test analysis. Results Reliability test results suggest that the scale of the total score and sub-item scores show a higher alpha-reliability coefficient. Thirty patients with improved thrombolytic therapy after mRS score ≤ 2 as the evaluation criteria for the effectiveness of thrombolytic intervention, the prognosis of patients with different thrombolytic intervention baseline risk-benefit scale score significant detection and analysis suggest that the improvement after thrombolysis group , No improvement group, there is a significant difference between the worsened group (P <0.01). POSThoc analysis suggested that the prediction of the cutoff point at 35 and 45 points as a good predictor of thrombolytic intervention, good prognosis, and poor prognosis showed better predictive power with areas under the ROC curve of 0.824 and 0.873, respectively. Conclusions On the platform of this study, the risk-benefit assessment scale for thrombolytic intervention in patients with vertebrobasilar arterial disease with acute ischemic cerebrovascular disease showed good reliability, validity, clinical utility, and economic value and is expected to be A new tool for predicting the risk and benefit of thrombolytic therapy and guiding decision-making on clinical thrombolysis.