急性脑卒中筛查量表的研究进展

doi:10.3761/j.issn.2096-7446.2023.07.019

摘要/Abstract

摘要： 脑卒中是引起致残的第三大原因,也是急诊科常见疾病之一。急性缺血性脑卒中处理强调早期诊断、早期治疗、早期康复和早期预防再发。在院前或急诊阶段早期识别是启动脑卒中诊治流程的首要步骤,筛查量表包括常用卒中筛查量表、预测大血管闭塞型脑卒中筛查量表和以眩晕为主要症状的后循环脑卒中筛查量表。该研究回顾国内外文献,对急性脑卒中筛查量表在院前或院内急诊中的应用进行综述,为早期准确识别提供科学依据。国内需建立与完善大血管闭塞型及以眩晕为主要症状的脑卒中筛查量表。

关键词: 脑卒中, 诊断筛查项目, 大血管闭塞, 眩晕, 急症护理

Abstract: Stroke is the third leading cause of disability,and is one of the common diseases in Emergency Department. The management of acute ischemic stroke emphasizes early diagnosis,early treatment,early rehabilitation and early prevention of recurrence. Early identification in the pre-hospital or Emergency Department is the first step to initiate the stroke diagnosis and treatment. The acute stroke screening scales include the common stroke screening scale,the scale with large vessel occlusion and vertigo as the main symptom. This paper reviews the application of acute stroke patient screening scale in pre-hospital or Emergency Department,so as to provide scientific basis for the identification of acute stroke in emergency medical care. However,there is a need to further develop and improve the stroke screening scales for large vessel occlusion and vertigo as the main symptom in China.

Key words: Stroke, Diagnostic Screening Programs, Large Vessel Occlusion, Vertigo, Emergency Nursing

周丽萍, 叶欢, 娄洁香, 褚惠林, 朱陈萍. 急性脑卒中筛查量表的研究进展[J]. 中华急危重症护理杂志, 2023, 4(7): 664-669.

ZHOU Liping, YE Huan, LOU Jiexiang, CHU Huilin, ZHU Chenping. Research progress of acute stroke screening scale[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(7): 664-669.

参考文献

[1] GBD Mortality and Causes of Death Collaborators. Global,re-gional,and national life expectancy,all-cause mortality,and cause-specific mortality for 249 causes of death,1980-2015:a systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet,2016,388(10053):1459-1544.
[2] 《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2019》概要[J]. 中国脑血管病杂志,2020,17(5):136-144.
Writing Group of China Stroke Prevention and Treatment Report. Brief report on stroke prevention and treatment in China,2019[J]. Chin J Cerebrovasc Dis,2020,17(5):136-144.
[3] Wang WZ,Jiang B,Sun HX,et al.Prevalence,incidence,and mor-tality of stroke in China:results from a nationwide population-based survey of 480 687 adults[J]. Circulation,2017,135(8):759-771.
[4] Wang DR,Liu JF,Liu M,et al.Patterns of stroke between uni-versity hospitals and nonuniversity hospitals in mainland China:prospective multicenter hospital-based registry study[J]. World Neurosurg,2017,98:258-265.
[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,彭斌,等. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.
Neurology Branch of Chinese Medical Association,Cerebro-vascular Disease Group of Neurology Branch of Chinese Medical Association,Peng B,et al. Chinese guidelines for diag-nosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol,2018,51(9):666-682.
[6] Powers WJ,Rabinstein AA,Ackerson T,et al.2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American heart association/American stroke association[J]. Stroke,2018, 49(3):e46-e110.
[7] Novakovic-White R,Corona JM,White JA.Posterior circulation ischemia in the endovascular era[J]. Neurology,2021,97(20 Suppl 2):S158-S169.
[8] Qiu DX,Zhang L,Deng J,et al.New insights into vertigo attack frequency as a predictor of ischemic stroke[J]. Front Neurol,2020,11:593524.
[9] Hanna J,Malhotra A,Brauer PR,et al.A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness[J]. Am J Otola-ryngol,2019,40(6):102263.
[10] Harbison J,Hossain O,Jenkinson D,et al.Diagnostic accuracy of stroke referrals from primary care,emergency room physicians,and ambulance staff using the face arm speech test[J]. Stroke,2003,34(1):71-76.
[11] El Ammar F,Ardelt A,Del Brutto VJ,et al.BE-FAST:a sensi-tive screening tool to identify In-hospital acute ischemic stroke[J]. J Stroke Cerebrovasc Dis,2020,29(7):104821.
[12] Aroor S,Singh R,Goldstein LB.BE-FAST(balance,eyes,face,arm,speech,time):reducing the proportion of strokes missed using the FAST mnemonic[J]. Stroke,2017,48(2):479-481.
[13] 周丽萍,娄洁香,张怡妮,等. BE-FAST量表在脑卒中患者急诊筛查中的应用[J]. 中华急诊医学杂志,2020,29(12):1627-1630.
Zhou LP,Lou JX,Zhang YN,et al.Application of BE-FAST scale in emergency screening of stroke patients[J]. Chin J Emerg Med,2020,29(12):1627-1630.
[14] 潘向滢,汪利萍,张月清,等. 脑卒中评价量表的研究进展[J]. 中华危重症医学杂志(电子版),2016,9(3):205-207.
Pan XY,Wang LP,Zhang YQ,et al.Research progress of stroke evaluation scale[J]. Chin J Crit Care Med(Electron Ed),2016, 9(3):205-207.
[15] 陈月馨,周惠芬,彭海菁,等. 洛杉矶院前卒中筛查量表在院前卒中的应用研究[J]. 脑与神经疾病杂志,2012,20(4):258-260.
Chen YX,Zhou HF,Peng HJ,et al.Application of Los Ange-les Prehospital Stroke Screen in prehospital stroke[J]. Chin J Brain and Neurol Dis,2012,20(4):258-260.
[16] Nor AM,Davis J,Sen B,et al.The Recognition of Stroke in the Emergency Room(ROSIER)scale:development and vali-dation of a stroke recognition instrument[J]. Lancet Neurol,2005,4(11):727-734.
[17] Fothergill RT,Williams J,Edwards MJ,et al.Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?[J]. Stroke,2013,44(11):3007-3012.
[18] 何明丰,吴智鑫,黎练达,等. 急诊脑卒中识别评分量表在社区院前急救中筛选价值的探讨[J]. 中国全科医学,2011,14(10):1088-1091.
He MF,Wu ZX,Li LD,et al.The value of the use of the ROSIER scale in community pre-hospital emergency care[J]. Chin Gen Pract,2011,14(10):1088-1091.
[19] Han F,Zuo C,Zheng GD.A systematic review and meta-ana-lysis to evaluate the diagnostic accuracy of recognition of stroke in the emergency department(ROSIER)scale[J]. BMC Neurol,2020,20(1):304.
[20] Mao HF,Lin PY,Mo JR,et al.Development of a new stroke scale in an emergency setting[J]. BMC Neurol,2016,16(1):168.
[21] 茅海峰. 脑卒中急诊筛查量表的设计研究[D]. 广州:广州医科大学,2013.
Mao HF.Development of a stroke emergency scale in an emergency setting[D]. Guangzhou:Guangzhou Medical Univer-sity,2013.
[22] Pérez de la Ossa N,Carrera D,Gorchs M,et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion:the rapid arterial occlusion evaluation scale[J]. Stroke,2014,45(1):87-91.
[23] Duvekot MHC,Venema E,Rozeman AD,et al.Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO):a prospective observational study[J]. Lancet Neurol,2021,20(3):213-221.
[24] 于善文,马春野,孙大鹏,等. 七种脑卒中筛查量表对急性缺血性脑卒中患者大血管闭塞的预测价值[J]. 中华老年心脑血管病杂志,2021,23(11):1137-1140.
Yu SW,Ma CY,Sun DP,et al.Value of seven stroke scale scores for predicting large vessel occlusion in AIS patients[J]. Chin J Geriatr Heart Brain Vessel Dis,2021,23(11):1137-1140.
[25] Smith EE,Kent DM,Bulsara KR,et al.Accuracy of prediction instruments for diagnosing large vessel occlusion in individuals with suspected stroke:a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke[J]. Stroke,2018,49(3):e111-e122.
[26] English SW,Rabinstein AA,Mandrekar J,et al.Rethinking pre-hospital stroke notification:assessing utility of emergency medical services impression and Cincinnati prehospital stroke scale[J]. J Stroke Cerebrovasc Dis,2018,27(4):919-925.
[27] Zhelev Z,Walker G,Henschke N,et al. Prehospital stroke sca-les as screening tools for early identification of stroke and transient ischemic attack[J]. Cochrane Database Syst Rev,2019, 4(4):CD011427.
[28] Richards CT,Huebinger R,Tataris KL,et al.Cincinnati preho-spital stroke scale can identify large vessel occlusion stroke[J]. Prehosp Emerg Care,2018,22(3):312-318.
[29] Stead TG,Banerjee P,Ganti L.Real-world field performance of the los angeles motor scale as a large vessel occlusion screen:a prospective muticentre study[J]. Cerebrovasc Dis,2021,50(5):543-550.
[30] Llanes JN,Kidwell CS,Starkman S,et al.The Los Angeles Motor Scale(LAMS):a new measure to characterize stroke severity in the field[J]. Prehosp Emerg Care,2004,8(1):46-50.
[31] Narwal P,Chang AD,Grory BM,et al.The addition of atrial fibrillation to the los angeles motor scale may improve prediction of large vessel occlusion[J]. J Neuroimaging,2019, 29(4):463-466.
[32] Navalkele D,Vahidy F,Kendrick S,et al.Vision,aphasia,ne-glect assessment for large vessel occlusion stroke[J]. J Stroke Cerebrovasc Dis,2020,29(1):104478.
[33] 热西达木·麦麦提,李红梅,金海燕,等. VAN量表筛查急性大动脉闭塞性缺血性卒中的价值[J]. 健康大视野,2021(6):1-2.
Maimaiti R,Li HM,Jin HY,et al.The value of VAN scale in screening acute ischemic stroke of aorta occlusion[J]. China Health Vis,2021(6):1-2.
[34] Birnbaum L,Wampler D,Shadman A,et al.Paramedic utili-zation of Vision,Aphasia,Neglect(VAN)stroke severity scale in the prehospital setting predicts emergent large vessel occlusion stroke[J]. J Neurointerv Surg,2021,13(6):505-508.
[35] Lima FO,Silva GS,Furie KL,et al.Field assessment stroke triage for emergency destination:a simple and accurate prehospital scale to detect large vessel occlusion strokes[J]. Stroke,2016,47(8):1997-2002.
[36] 蔡浩荻. FAST-ED评分对急性缺血性大血管闭塞型脑卒中的预测作用[D]. 南京:东南大学,2020.
Cai HD.Validation of prediction value of FAST-ED Scale on large vessel occlusion acute ischemic stroke[D]. Nanjing:Southeast University,2020.
[37] Frank B,Fabian F,Brune B,et al.Validation of a shortened FAST-ED algorithm for smartphone app guided stroke triage[J]. Ther Adv Neurol Disord,2021,14:17562864211057639.
[38] Arch AE,Weisman DC,Coca S,et al.Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services[J]. Stroke,2016,47(3):668-673.
[39] Saber Tehrani AS,Kattah JC,Kerber KA,et al.Diagnosing stroke in acute dizziness and vertigo:pitfalls and pearls[J]. Stroke,2018,49(3):788-795.
[40] Johnston SC,Rothwell PM,Nguyen-Huynh MN,et al.Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack[J]. Lancet,2007,369(9558):283-292.
[41] Kim JS,Newman-Toker DE,Kerber KA,et al.Vascular vertigo and dizziness:diagnostic criteria[J]. J Vestib Res,2022,32(3):205-222.
[42] Wardlaw JM,Brazzelli M,Chappell FM,et al.ABCD2 score and secondary stroke prevention:meta-analysis and effect per 1,000 patients triaged[J]. Neurology,2015,85(4):373-380.
[43] Gerlier C,Hoarau M,Fels A,et al.Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS,STANDING,and ABCD2 tests:a diagnostic cohort study[J]. Acad Emerg Med,2021,28(12):1368-1378.
[44] Kim Y,Faysel M,Balucani C,et al.Ischemic stroke predictors in patients presenting with dizziness,imbalance,and vertigo[J]. J Stroke Cerebrovasc Dis,2018,27(12):3419-3424.
[45] 湖北省脑卒中防治中心质量控制组. 急性后循环缺血性卒中早期识别与评估专家共识[J]. 卒中与神经疾病,2021,28(2):245-250.
Quality Control Group of Hubei Stroke Prevention and Control Center. Expert consensus on early identification and eva-luation of acute posterior circulation ischemic stroke[J]. Stroke Nerv Dis,2021,28(2):245-250.
[46] Dmitriew C,Regis A,Bodunde O,et al.Diagnostic accuracy of the HINTS exam in an emergency department:a retrospective chart review[J]. Acad Emerg Med,2021,28(4):387-393.