| 重症颅脑损伤患者术后硬膜下积液的危险因素及预测模型构建 |
| 投稿时间：2024-12-13 修订日期：2025-01-20 点此下载全文 |
| 引用本文：孙夕峰,窦力,唐勇,樊永忠.重症颅脑损伤患者术后硬膜下积液的危险因素及预测模型构建[J].医学研究杂志,2025,54(6):109-113, 148 |
| DOI：
10.11969/j.issn.1673-548X.2025.06.020 |
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| 基金项目:江苏省卫生健康委员会科研项目(M2020077) |
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| 中文摘要:目的 分析重症颅脑损伤(severe traumatic brain injury,sTBI)患者术后硬膜下积液(subdural effusion,SE)的危险因素,并创建预测患者术后SE发生的列线图预测模型。方法 回顾性分析2020年3月～2023年12月丹阳市人民医院收治的223例sTBI患者的临床资料,根据术后有无发生SE分为SE组和非SE组。对SE组和非SE组收集的24项资料予以比较,利用多因素Logistic回归分析筛查术后SE发生的危险因素。将确定的预测变量引入R软件构建列线图模型,并利用受试者工作特征(receiver operator characteristic,ROC)曲线下面积(area under the curve,AUC)、校正曲线检验模型的预测效果。结果 sTBI患者术后SE发生率为27.80%(62/223)；SE组和非SE组入院格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、血肿量、基底池受压比例、蛛网膜下腔出血(subarachnoid hemorrhage,SAH)比例、中线移位距离、脱水剂应用时间≥7天比例、术后颅内感染比例比较,差异均有统计学意义(P＜0.05)；sTBI患者术后SE发生的危险因素主要有入院GCS评分为3～5分、血肿量＞40ml、基底池受压、SAH、中线移位距离≥10mm、脱水剂应用时间≥7天。内部验证显示,AUC为0.828(95% CI:0.784～0.896),拟合优度Hosmer-Lemeshow检验结果为χ2=6.860,P=0.552,曲线拟合度较佳。结论 根据入院GCS评分、血肿量、基底池是否受压、是否发生SAH、中线移位距离及脱水剂应用时间构建的列线图对sTBI患者术后SE发生的预测效果良好。 |
| 中文关键词:重症颅脑损伤 硬膜下积液 危险因素 列线图 |
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| Risk Factors for Postoperative Subdural Effusion in Patients with Severe Traumatic Brain Injury and the Construction of a Column Chart Prediction Model |
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| Abstract:Objective To analyze the risk factors for postoperative subdural effusion (SE) in patients with severe traumatic brain injury (sTBI) and create a column chart to predict the occurrence of postoperative SE in patients. Methods A retrospective analysis was conducted on the data of 223 patients with sTBI admitted to The People′s Hospital of Danyang from March 2020 to December 2023. They were divided into SE group and non-SE group based on with or without postoperative SE. 24 items of data collected from the SE group and non-SE group were compared, and multivariate Logistic regression were applied to analyze and screen for risk factors of postoperative SE occurrence. The determined predictive variables were introduced into R software to construct a column chart model, and the area under the receiver operator characteristic curve (ROC) curve (area under the curve,AUC) and correction curve were applied to test the predictive performance of the model. Results The incidence of postoperative SE in sTBI patients was 27.80% (62/223). There were statistically obvious differences between the SE group and the non-SE group in terms of Glasgow coma scale (GCS) scores at admission, hematoma volume, proportion of basilar cistern compression, proportion of subarachnoid hemorrhage (SAH), midline displacement distance, dehydrating agent application time ≥7days, and postoperative intracranial infection rate (P<0.05). The risk factors for postoperative SE in patients with sTBI mainly included admission GCS score of 3-5 points, hematoma volume > 40ml, basal pool compression, SAH, midline displacement distance≥10mm, and application time of dehydrating agent ≥7days. Internal validation showed that the AUC was 0.840 (95% CI:0.784-0.896), and the goodness of fit Hosmer-Lemeshow test showed χ2=6.860, P=0.552, with better curve fitting. Conclusion A column chart based on GCS score at admission, hematoma volume, whether the basal pool, whether SAH, midline displacement distance and time of dehydrating agent application has a good predictive effect on postoperative SE occurrence in sTBI patients. |
| keywords:Severe traumatic brain injury Subdural effusion Risk factors Column chart |
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