单纯重度脑创伤患者发生深静脉血栓危险因素分析及其列线图模型构建  

Risk Factors Analysis and Establishment of Nomogram Model for Deep Vein Thrombosis in Patients with Simple and Severe Cerebral Trauma

作　　者：杜伟 郝质言 李方[1] 李育[1] DU Wei;HAO Zhiyan;LI Fang;LI Yu(Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院,新疆维吾尔自治区乌鲁木齐市830001

出　　处：《实用心脑肺血管病杂志》2021年第6期28-33,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景预防重度脑创伤患者并发深静脉血栓(DVT)一直是神经外科的工作重点。目的探讨单纯重度脑创伤患者发生DVT的危险因素,并构建相关列线图模型。方法选取2017年1月—2020年6月入住新疆维吾尔自治区人民医院ICU的单纯重度脑创伤患者197例为研究对象。收集患者临床资料,包括性别、年龄、体质指数(BMI)、吸烟情况、糖尿病发生情况、高血压发生情况、高脂血症发生情况、冠心病发生情况、蛛网膜下腔出血发生情况、血肿发生情况、深静脉置管情况、凝血酶原时间、格拉斯哥昏迷量表(GCS)评分和手术时间。根据DVT发生情况,将患者分为DVT组(n=38)和非DVT组(n=159)。采用多因素Logistic回归分析探讨单纯重度脑创伤患者发生DVT的危险因素;采用R-3.5.3软件包和rms程序包构建列线图模型;采用Bootstrap法进行内部验证,采用一致性指数(CI)、校正曲线和受试者工作特征(ROC)曲线评估列线图模型的预测价值。结果多因素Logistic回归分析结果显示,糖尿病〔OR=4.674,95%CI(1.017,21.483)〕、高血压〔OR=5.478,95%CI(2.072,14.480)〕、凝血酶原时间<12 s〔OR=18.963,95%CI(5.459,65.864)〕、GCS评分<5分〔OR=4.333,95%CI(1.637,11.466)〕和手术时间≥3 h〔OR=8.558,95%CI(2.815,26.013)〕是单纯重度脑创伤患者发生DVT的独立危险因素(P<0.05)。基于单纯重度脑创伤患者发生DVT影响因素的多因素Logistic回归分析结果,建立预测单纯重度脑创伤患者发生DVT的列线图模型,内部验证结果显示:CI为0.887;列线图模型预测单纯重度脑创伤患者发生DVT的校正曲线趋近于理想曲线;列线图模型预测单纯重度脑创伤患者发生DVT的ROC曲线下面积(AUC)为0.900〔95%CI(0.865,0.937)〕。结论糖尿病、高血压、凝血酶原时间<12 s、GCS评分<5分、手术时间≥3 h是单纯重度脑创伤患者发生DVT的危险因素,基于这些危险因素构建的列线图模型能够准确预测单纯重�Background Prevention of deep venous thrombosis(DVT)in patients with severe cerebral trauma has always been the focus of neurosurgery.Objective To explore the risk factors of DVT in patients with simple and severe cerebral trauma,and to construct the related nomogram model.Methods A total of 197 patients with simple and severe cerebral trauma admitted to ICU of Hospital of Xinjiang Uygur Autonomous Region from January 2017 to June 2020 were selected as the research objects.The clinical data were collected,including gender,age,body mass index(BMI),smoking,diabetes,hypertension,hyperlipidemia,coronary heart disease,subarachnoid hemorrhage,hematoma,deep vein catheterization,prothrombin time,Glasgow Coma Scale(GCS)score and operation time.According to the occurrence of DVT,the patients were divided into DVT group(n=38)and non DVT group(n=159).Multivariate Logistic regression analysis was used to explore the risk factors of DVT in patients with simple and severe cerebral trauma.R-3.5.3 software package and rms package were used to build nomogram model.The Bootstrap method was used for internal verification,and the consistency index(CI),calibration curve and receiver operating characteristic(ROC)curve were used to evaluate the predictive value of the nomogram model.Results Multivariate Logistic regression analysis showed that diabetes〔OR=4.674,95%CI(1.017,21.483)〕,hypertension〔OR=5.478,95%CI(2.072,14.480)〕,prothrombin time<12 s〔OR=18.963,95%CI(5.459,65.864)〕,GCS score<5〔OR=4.333,95%CI(1.637,11.466)〕and operation time≥3 h〔OR=8.558,95%CI(2.815,26.013)〕were independent risk factors for DVT in patients with simple and severe cerebral trauma(P<0.05).Based on the results of multivariate Logistic regression analysis of the influencing factors of DVT in patients with simple and severe cerebral trauma,a nomogram model for predicting DVT in patients with simple and severe cerebral trauma was established.Internal verification results show that:CI was 0.887;the calibration curve of nomogram model for predicti

关 键 词：颅脑损伤 深静脉血栓 危险因素 列线图 

分 类 号：R651[医药卫生—外科学]