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Updated: Jan 27, 2026

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动脉瘤下结出血后的预后:修改后的亨特和赫斯分级尺度
Fawaz Al-Mufti1, Alis J Dicpinigaitis1, Christian A Bowers2
1Department of Neurosurgery Westchester Medical Center at New York Medical College Valhalla NY USA.
Stroke (Hoboken, N.J.)
|January 26, 2026
概括
一个修改的亨特和赫斯 (mHH) 尺度通过结合格拉斯哥昏迷尺度得分来改善严重动脉瘤下关节出血 (aSAH) 的预后. 与传统的尺度相比,mHH尺度在预测糟糕的结果方面提供了更好的准确性.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 动脉瘤下关节出血 (aSAH) 需要准确的预后,以实现最佳的患者管理.
- 传统的亨特和赫斯 (tHH) 尺度是一个标准,但在区分最严重的病例时可能缺乏精度.
- 脑干功能障碍,以低格拉斯哥昏迷度量 (GCS) 评分来表示,显著影响aSAH的结果.
研究的目的:
- 引入和验证修改后的亨特和赫斯 (mHH) 评分尺度,以改善aSAH的预后.
- 通过将GCS得分纳入tHH尺度来增强严重aSAH患者的差异化.
- 将mHH尺度的诊断性能与tHH尺度进行比较,用于预测aSAH的不良结果.
主要方法:
- 从国家住院患者样本 (2015-2019) 中对加权的aSAH住院病人的回顾性分析.
- 根据tHH和拟议的mHH等级对患者进行分层,mHH等级5由tHH等级5和GCS 3-5定义.
- 诊断性能指标的比较,包括歧视 (c-统计),特异性和正预测值 (PPV),使用NIS-SAH结果指标 (NIS-SOM).
- 使用前性维护的aSAH注册表对mHH尺度进行外部验证.
主要成果:
- 在6130例aSAH住院病例中,36%是5级的mHH,其中35%符合5级的mHH标准 (GCS 3-5).
- 与tHH尺度相比,mHH尺度显示出较差结果的优异歧视 (c-统计值为0.793对比0.780).
- 与tHH相比,mHH显示显著提高了特异性 (0.929比0.304) 和PPV (0.949比0.827).
- 外部验证证实了mHH (c-统计值0.835) 的优异区别,具有高特异性 (0.950) 和PPV (0.905).
结论:
- 修改后的亨特和赫斯 (mHH) 尺度提供了更准确和更具体的方法来预测动脉瘤下关节出血的预后.
- mHH尺度有效地区分高严重性aSAH患者,特别是脑干功能障碍患者.
- 这种增强的分级系统可能会改善严重的aSAH病例的临床决策和患者结果.
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