The Study Of The Relationship Among Ocsp Subtypes, Nihss Scale And The Chinese Clinical Neurological Defect Scale With The Prognosis In Ischemic Stroke

Objective To study the difference of NIHSS scale and the Chinese Clinical Neurological Defect scale among the ischemic stroke OCSP subtypes, whether there are the Barthel Index's differences and correlations between the two scales, to choose suitable neurological defect clinical rating scales evaluating pathogenetic condition and measuring termination.Mthods Prospective continuously collected all the case data of ischemic stroke patients admitted to the department of neurology of our hospital from 2008.11 ~2009.12, there were 586 patients coincided with the criteria, they were classified into Oxfordshire Community Stroke Project subtypes when in hospital, were tested with the National Institutes of Health Stroke Scale and the Chinese Clinical Neurological Defect scale respectively at admission, then calculated case fatality rate when they were followed up at 90 day after stroke and tested with the Barthel index at discharge to follow-up visit each activities of daily living by telephone or out-patient clinic. Compared NIHSS scale and the Chinese Clinical Neurological Defect scale of each OCSP subtype, and analysised their correlations with the Barthel index.Results (1) Contrast the OCSP subtypes'constituent ratio of the ischemic stroke patients, the 1acunar infarct patients occupy the largest proportion, then the partial anterior circulation infarct patients, the total anterior circulation infarct patients, the smallest were the posterior circulation infarct patients. Each OCSP subtype were not significantly different between the ages and the genders. Compared the results of the patients'neurologic deficits on admission with that of the MR diagnosis and/or after 24 hours of CT, the total concordance rate was 89.2%, the concordance rate of TACI was 90.5%, PACI was 83.6%, POCI was 82.5%, LACI was 92.5%. It indicated the OCSP subtypes and the imaging diagnosis results had favourable coincidence.(2)Compare the NIHSS scores of each OCSP subtype when they were on admission, the differences have statistical significance, the NIHSS score of TACI is the highest, indicate the most serious neurologic deficit, the lowest Barthel Index and the highest case fatality rate at 90 day after stroke and compared with other subtypes has statistically significant differences(P<0.01), the worst prognosis. The NIHSS score of LACI is the lowest, indicate the mildest neurologic deficit, the highest Barthel Index and 0 case fatality rate at 90 day after stroke, the best prognosis. (3)Compare the Chinese Clinical Neurological Defect scale scores of each OCSP subtype when they were on admission, the differences have statistical significance, the Chinese Clinical Neurological Defect scale score of TACI is the highest, indicate the most serious neurologic deficit; the Chinese Clinical Neurological Defect scale score of LACI is the highest, indicate the mildest neurologic deficit.(4)The differences of the NIHSS scores and the Chinese Clinical Neurological Defect scale scores between survival and decease group in have statistical significance, and the two scores of the decease group are all significantly higher than the survival group. Compare each OCSP subtype of the NIHSS and the Chinese Clinical Neurological Defect scale, we can conclude: the coefficient correlation of the NIHSS and Barthel Index in TACI and PACI is higher than the Chinese Clinical Neurological Defect scale; the coefficient correlation of the Chinese Clinical Neurological Defect scale and Barthel Index in POCI and LACI is higher than the NIHSS. These indicate the more suitable measuring scale of TACI and PACI is the NIHSS; the more suitable measuring scale of POCI and LACI is the Chinese Clinical Neurological Defect scale. So when evaluating pathogenetic condition and measuring termination, we suggest choose the more suitable measuring scale or combine the two measuring scales.Conclusions For the ischemic stroke patient, OCSP classification in the early onset, choose the more suitable measuring scale or combine the two measuring scales can be used to evaluate pathogenetic condition, guide the direct treatment, measure termination and right health education.