美国国立卫生研究院卒中量表的演变与应用：从历史发展到评估标准的改进

doi:10.3969/j.issn.1673-5765.2025.08.011

摘要/Abstract

摘要： 自1989年被首次提出以来，NIHSS一直是卒中评估领域的核心工具。目前，该量表已成为评估卒中严重程度的“金标准”。本文全面回顾NIHSS的诞生与发展、临床应用现状及局限性，并介绍了5种改良版NIHSS，旨在优化NIHSS的学习路径，提升神经科医师在临床中应用该量表的水平，并为NIHSS的改良和应用提供参考。

文章导读： 本文对NIHSS进行了全面的回顾和综述，总结了2024版NIHSS的更新内容，并提出了未来NIHSS的研究方向，以便NIHSS能更好地应用于临床试验与实践。

关键词: 卒中; 美国国立卫生研究院卒中量表; 临床应用; 量表改良

Abstract: Since its initial introduction in 1989, the NIHSS has remained a core tool in stroke assessment. Currently, it has become the “gold standard” for evaluating stroke severity. This article comprehensively reviews the birth and development of the NIHSS, its current status of clinical applications, and limitations, and introduces five modified versions of the NIHSS. The aim is to optimize the learning pathway for NIHSS, enhance the proficiency of neurologists in applying this scale in clinical practice, and offer insights for the refinement and application of the NIHSS.

Key words: Stroke; National Institutes of Health stroke scale; Clinical application; Scale improvement

中图分类号:

董茜, 胡晓, 李琦. 美国国立卫生研究院卒中量表的演变与应用：从历史发展到评估标准的改进[J]. 中国卒中杂志, 2025, 20(8): 1022-1028.

DONG Qian, HU Xiao, LI Qi. The Evolution and Applications of the National Institutes of Health Stroke Scale: From Historical Development to Improvement of Assessment Criteria[J]. Chinese Journal of Stroke, 2025, 20(8): 1022-1028.

参考文献

[1] GBD 2019 Stroke Collaborators. Global，regional，and national burden of stroke and its risk factors，1990-2019：a systematic analysis for the global burden of disease study 2019[J]. Lancet Neurol，2021，20（10）：795-820.
[2] 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. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志，2024，57（6）：523-559.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol，2024，57（6）：523-559.
[3] LYDEN P. Using the National Institutes of Health stroke scale：a cautionary tale[J]. Stroke，2017，48（2）：513-519.
[4] National Institute of Neurological Disorders and Stroke. NIH stroke scale updated with new visual stimuli[EB/OL].（2024-03-01）[2025-07-17]. https://www.ninds.nih.gov/news-events/news/highlights-announcements/nih-stroke-scale-updated-new-visual-stimuli?utm_source=chatgpt.com.
[5] BROTT T，ADAMS H P，Jr，OLINGER C P，et al. Measurements of acute cerebral infarction：a clinical examination scale[J]. Stroke，1989，20（7）：864-870.
[6] GOLDSTEIN L B，BERTELS C，DAVIS J N. Interrater reliability of the NIH stroke scale[J]. Arch Neurol，1989，46（6）：660-662.
[7] BROTT T G，HALEY E C，Jr，LEVY D E，et al. Urgent therapy for stroke. Part Ⅰ. Pilot study of tissue plasminogen activator administered within 90 minutes[J]. Stroke，1992，23（5）：632-640.
[8] LYDEN P，BROTT T，TILLEY B，et al. Improved reliability of the NIH stroke scale using video training[J]. Stroke，1994，25（11）：2220-2226.
[9] STOCKBRIDGE M D，KELLY L，NEWMAN-NORLUND S，et al. New picture stimuli for the NIH stroke scale：a validation study[J]. Stroke，2024，55（2）：443-451.
[10] WATT J K，QUINN T J. Critical look at the NIHSS visual stimuli[J]. Stroke，2024，55（2）：452-453.
[11] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2025-07-17]. https://doi.org/10.1161/STR.0000000000000211.
[12] The European Agency for the Evaluation of Medicinal Products. Summary information on a referral opinion following an arbitration pursuant to article 29 of directive 2001/83/EC for dacarbazine faulding，100 mg，200 mg and 600 mg powder for solution for injection[R]. London：EMEA，2002.
[13] KWAH L K，DIONG J. National Institutes of Health stroke scale（NIHSS）[J]. J Physiother，2014，60（1）：61.
[14] ADAMS H P，Jr，DAVIS P H，LEIRA E C，et al. Baseline NIH stroke scale score strongly predicts outcome after stroke：a report of the trial of Org 10172 in acute stroke treatment（TOAST）[J]. Neurology，1999，53（1）：126-131.
[15] MISTRY E A，YEATTS S，DE HAVENON A，et al. Predicting 90-day outcome after thrombectomy：baseline-adjusted 24-hour NIHSS is more powerful than NIHSS score change[J]. Stroke，2021，52（8）：2547-2553.
[16] MANTERO V，SCACCABAROZZI C，ALIPRANDI A，et al. NIHSS as predictor of clinical outcome at 6 months in patients with intracerebral hemorrhage[J]. Neurol Sci，2020，41（3）：717-719.
[17] YOU S J，WANG Y N，WANG X，et al. Twenty-four-hour post-thrombolysis NIHSS score as the strongest prognostic predictor after acute ischemic stroke：ENCHANTED study[J/OL]. J Am Heart Assoc，2024，13（18）：e036109[2025-07-17]. https://doi.org/10.1161/JAHA.124.036109.
[18] CHENG Z，GENG X K，RAJAH G B，et al. NIHSS consciousness score combined with ASPECTS is a favorable predictor of functional outcome post endovascular recanalization in stroke patients[J]. Aging Dis，2021，12（2）：415-424.
[19] SAITO T，ITABASHI R，YAZAWA Y，et al. Clinical outcome of patients with large vessel occlusion and low National Institutes of Health stroke scale scores：subanalysis of the RESCUE-Japan registry 2[J]. Stroke，2020，51（5）：1458-1463.
[20] SHUAIB A，JEERAKATHIL T. The mobile stroke unit and management of acute stroke in rural settings[J/OL]. CMAJ，2018，190（28）：E855-E858[2025-07-17]. https://doi.org/10.1503/cmaj.170999.
[21] HARMEL P，EBINGER M，FREITAG E，et al. Functional stroke outcomes after mobile stroke unit deployment—the revised protocol for the Berlin prehospital or usual delivery of acute stroke care（B_PROUD）part 2 study[J/OL]. Neurol Res Pract，2019，1：18[2025-07-17]. https://doi.org/10.1186/s42466-019-0022-4.
[22] BOWRY R，PARKER S，RAJAN S S，et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management：the BEST-MSU study run-in phase[J]. Stroke，2015，46（12）：3370-3374.
[23] HOV M R，RØISLIEN J，LINDNER T，et al. Stroke severity quantification by critical care physicians in a mobile stroke unit[J]. Eur J Emerg Med，2019，26（3）：194-198.
[24] SJÖQVISTB A，HAGIWARA M A，NORDANSTIG A. Telemedicine utilizing video streaming in prehospital assessment of stroke—an opportunity to shorten time to thrombectomy[J]. Health Technol，2025，15：601-609.
[25] WEISS D，RUBBERT C，KASCHNER M，et al. Prehospital telemedicine support for urban stroke care：analysis of current state of care and conceptualization[J/OL]. BMC Emerg Med，2024，24（1）：224[2025-07-17]. https://doi.org/10.1186/s12873-024-01142-3.
[26] GEISLER F，KUNZ A，WINTER B，et al. Telemedicine in prehospital acute stroke care[J/OL]. J Am Heart Assoc，2019，8（6）：e011729[2025-07-17]. https://doi.org/10.1161/JAHA.118.011729.
[27] GARAVELLI F，GHELFI A M，KILSTEIN J G. Usefulness of NIHSS score as a predictor of non-neurological in-hospital complications in stroke[J]. Med Clin（Barc），2021，157（9）：434-437.
[28] ZÖLLNER J P，MISSELWITZ B，KAPS M，et al. National Institutes of Health stroke scale（NIHSS）on admission predicts acute symptomatic seizure risk in ischemic stroke：a population-based study involving 135 117 cases[J/OL]. Sci Rep，2020，10（1）：3779[2025-07-17]. https://doi.org/10.1038/s41598-020-60628-9.
[29] WU D，LIU Y E. FM combined with NIHSS score contributes to early AIS diagnosis and differential diagnosis of cardiogenic and non-cardiogenic AIS[J/OL]. Clin Appl Thromb Hemost，2021，27：10760296211000129[2025-07-17]. https://doi.org/10.1177/10760296211000129.
[30] YUAN S H，LI W L，HOU C B，et al. Serum occludin level combined with NIHSS score predicts hemorrhage transformation in ischemic stroke patients with reperfusion[J/OL]. Front Cell Neurosci，2021，15：714171[2025-07-17]. https://doi.org/10.3389/fncel.2021.714171.
[31] XIONG Y Y，CAMPBELL B C V，SCHWAMM L H，et al. Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy[J]. N Engl J Med，2024，391（3）：203-212.
[32] CHENG X，HONG L，LIN L T，et al. Tenecteplase thrombolysis for stroke up to 24 hours after onset with perfusion imaging selection：the CHABLIS-T Ⅱ randomized clinical trial[J]. Stroke，2025，56（2）：344-354.
[33] LYDEN P D，LU M，LEVINE S R，et al. A modified National Institutes of Health stroke scale for use in stroke clinical trials：preliminary reliability and validity[J]. Stroke，2001，32（6）：1310-1307.
[34] MEYER B C，HEMMEN T M，JACKSON C M，et al. Modified National Institutes of Health stroke scale for use in stroke clinical trials：prospective reliability and validity[J]. Stroke，2002，33（5）：1261-1266.
[35] OLIVATO S，NIZZOLI S，CAVAZZUTI M，et al. e-NIHSS：an expanded National Institutes of Health stroke scale weighted for anterior and posterior circulation strokes[J]. J Stroke Cerebrovasc Dis，2016，25（12）：2953-2957.
[36] KAZI S A，SIDDIQUI M，MAJID S. Stroke outcome prediction using admission NIHSS in anterior and posterior circulation stroke[J]. J Ayub Med Coll Abbottabad，2021，33（2）：274-278.
[37] YAO M，HERVÉ D，ALLILI N，et al. NIHSS scores in ischemic small vessel disease：a study in CADASIL[J]. Cerebrovasc Dis，2012，34（5/6）：419-423.
[38] TIRSCHWELL D L，LONGSTRETH W T，Jr，BECKER K J，et al. Shortening the NIH stroke scale for use in the prehospital setting[J]. Stroke，2002，33（12）：2801-2806.
[39] ROUSHDY T，ABDEL NASSER A，NASEF A，et al. A clinical comparative analysis between expanded NIHSS and original NIHSS in posterior circulation ischemic stroke[J/OL]. J Clin Neurosci，2023，114：77-80[2025-07-17]. https://doi.org/10.1016/j.jocn.2023.06.006.
[40] ALEMSEGED F，ROCCO A，ARBA F，et al. Posterior National Institutes of Health stroke scale improves prognostic accuracy in posterior circulation stroke[J]. Stroke，2022，53（4）：1247-1255.
[41] LI Q，DENG L，HUANG C，et al. A novel scale for assessment of stroke severity at symptom onset：correlation with neurological deterioration and outcome[J/OL]. Front Neurol，2021，11：602839[2025-07-17]. https://doi.org/10.3389/fneur.2020.602839.