个性化预测创伤性蛛网膜下腔出血并发脑积水的风险模型建立  

Establishment of a personalized model to predict the risk of traumatic subarachnoid hemorrhage complicated with hydrocephalus

作　　者：邵世蓉 邓天芳[1] 王艳[1] 刘莎莎 王姣姣 李政[1] SHAO Shi-rong;DENG Tian-fang;WANG Yan;LIU Sha-sha;WANG Jiao-Jiao;LI Zheng(Department of Neurosurgery,Deyang people's Hospital,Deyang City,Sichuan Province,618000,China)

机构地区：[1]四川省德阳市人民医院神经外科,四川德阳618000

出　　处：《蛇志》2022年第3期311-315,共5页Journal of Snake

基　　金：四川省卫生健康委员会2021年医学科技项目(项目名称:基于机器学习的内镜下经鼻蝶鞍区垂体瘤术后患者嗅觉障碍易感因素及风险预测模型研究,项目编号:21PJ171)。

摘　　要：目的探讨列线图个体化预测创伤性蛛网膜下腔出血并发脑积水风险模型的建立。方法选取2018年8月~2019年10月我院收治的创伤性蛛网膜下腔出血患者160例,根据有无发生脑积水进行分组,其中发生脑积水组46例,未发生脑积水组114例。采用单因素分析统计两组患者的临床资料,包括年龄、性别、高血压、糖尿病、护理干预、颅内血肿、水肿、脑脊液通道闭塞、格拉斯哥昏迷评分法(GCS评分)、Hunt-Hess等级、去骨瓣减压术、出血位置、出血分布、出血厚度;采用Logistic回归分析法筛选出创伤性蛛网膜下腔出血并发脑积水的独立风险因素,并建立列线图预测模型。结果性别、水肿、出血位置及出血分布比较,差异均无统计学意义(均P>0.05)。两组患者的年龄、高血压、糖尿病、护理干预、颅内血肿、脑脊液通道闭塞、GCS评分、Hunt-Hess等级、去骨瓣减压术、出血厚度比较,差异均有统计学意义(均P<0.05)。通过Logistic二元回归分析结果显示,年龄、颅内血肿、脑脊液通道闭塞、去骨瓣减压术、出血厚度为创伤性蛛网膜下腔出血并发脑积水的独立风险因素。列线图模型的Calibration验证结果显示,预测值与实测值曲线重合度较高;同时Bootstrap内部验证结果显示,C-index指数高达0.808(95%CI 0.848~0.928)。结论创伤性蛛网膜下腔出血并发脑积水患者,年龄、颅内血肿情况,脑脊液通道粘连闭塞、颅内高压去骨瓣减压术、出血厚度等因素均会产生明显影响,临床上应根据上述因素制定合理的治疗方案,做好脑积水的预防措施,从而改善创伤性蛛网膜下腔出血患者的预后。Objective To study and discuss the establishment of a risk model for predicting traumatic subarachnoid hemorrhage(SAH)complicated by hydrocephalus with individual nomographs.Methods A total of 160 patients with traumatic subarachnoid hemorrhage admitted to our hospital from August 2018 to October 2019 were selected,including 46 patients with hydrocephalus and 114 patients without hydrocephalus.The clinical data of the patients were analyzed by univariate analysis.Specifically,age,gender,hypertension,diabetes,nursing intervention,intracranial hematoma,edema,cerebrospinal fluid channel occlusion,Glasgow coma score(GCS score),Hunt-Hess grade,decompression by decompression,bleeding location,bleeding distribution and bleeding thickness;the independent risk factors of traumatic subarachnoid hemorrhage complicated with hydrocephalus were screened by Logistic regression analysis and the linear graph prediction model was established.Results There were no statistically significant differences in gender,edema,bleeding location and bleeding distribution(P>0.05 for each),but there were statistically significant differences in age,hypertension,diabetes,nursing intervention,intracranial hematoma,cerebrospinal fluid channel occlusion,GCS score,Hunt-Hess grade,decompression and bleeding thickness between the two groups(P<0.05 for each).Logistic regression analysis showed that age,intracranial hematoma,cerebrospinal fluid channel occlusion,decompressive craniectomy and bleeding thickness were independent risk factors for traumatic subarachnoid hemorrhage complicated with hydrocephalus.The Calibration results of the line graph model show that the predicted value has a high coincidence with the measured value.Meanwhile,Bootstrap internal verification results showed that c-index was as high as 0.808(95%CI:0.848-0.928).Conclusion In patients with traumatic subarachnoid hemorrhage complicated by hydrocephalus,age,intracranial hematoma,adhesion and occlusion of cerebrospinal fluid channels,intracranial high-pressure debonding,bleeding t

关 键 词：蛛网膜下腔出血 脑积水 并发症 列线图 预测模型 

分 类 号：R543[医药卫生—心血管疾病]