重型颅脑损伤患者术后脑膨出的影响因素及风险预测模型的构建  

Influencing factors of postoperative encephalocele in patients with severe craniocerebral injury and construction of risk prediction model

作　　者：张华 刘广明 Zhang Hua;Liu Guangming(Department of Critical Medicine,Pidu District People’s Hospital,Chengdu 611730,China)

机构地区：[1]郫都区人民医院重症医学科,成都611730

出　　处：《中华脑科疾病与康复杂志（电子版）》2022年第2期96-102,共7页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的探讨重型颅脑损伤(TBI)患者术后发生脑膨出的影响因素,并建立重型TBI患者术后发生脑膨出风险预测模型。方法选择郫都区人民医院重症医学科自2018年1月至2020年2月收治的126例重型TBI患者为研究对象,根据术后脑膨出发生与否,分为脑膨出组和非脑膨出组。收集2组患者一般临床资料,采用单因素及多因素分析重型TBI患者术后发生脑膨出的危险因素,采用R(R3.5.3)建立预测重型TBI患者术后发生脑膨出的风险列线图模型。结果脑膨出组患者42例,脑膨出发生率为33.33%(42/126),非脑膨出组84例。单因素分析结果显示,手术远隔部位颅骨骨折、抗凝药物服用史、脑积水、颅内感染、迟发性外伤性颅内血肿(DTIH)、外伤性弥漫性脑肿胀(PADBS)、术前颅内压、血小板计数以及凝血酶原时间是术后脑膨出的影响因素(P<0.05)。多因素Logistic回归分析结果显示,合并手术远隔部位颅骨骨折、抗凝药物服用史、脑积水、DTIH、PADBS以及术前颅内压均为重型TBI患者术后发生脑膨出的危险因素(P<0.05)。列线图模型结果显示,模型一致性指数为0.857(95%CI:0.823~0.891),校正曲线与理想曲线基本一致,受试者工作特征曲线下面积为0.848(95%CI:0.817~0.879)。结论合并手术远隔部位颅骨骨折、伴有抗凝药物服用史、伴有脑积水、合并DTIH、合并PADBS以及术前颅内压均为重型TBI患者术后发生脑膨出的独立危险因素,基于上述6项危险因素所建立的风险预测模型有助于预测重型TBI患者术后脑膨出的发生风险。Objective To investigate the influencing factors of postoperative encephalocele in patients with severe traumatic brain injury(TBI),and to establish a risk prediction model for postoperative encephalocele in patients with severe TBI.Methods A total of 126 patients with severe TBI who were treated in Critical Medicine Department of Pidu District People’s Hospital from January 2018 to February 2020 were selected as the research objects.According to the occurrence of postoperative encephalocele,they were divided into encephalocele group and non encephalocele group.The general clinical data of the two groups were collected,and the risk factors of postoperative encephalocele in patients with severe TBI were analyzed by univariate and multivariate factors.R(R3.5.3)was used to establish a nomographic model for predicting the risk of encephalocele in patients with severe TBI after surgery.Results There were 42 patients in the encephalocele group,the incidence of encephalocele was 33.33%(42/126),and 84 patients in the non-encephalocele group.Univariate analysis showed that the influencing factors of postoperative encephalocele were distal skull fracture,history of anticoagulation,hydrocephalus,intracranial infection,delayed traumatic intracranial hematoma(DTIH),post-traumatic acute diffuse brain swelling(PADBS),preoperative intracranial pressure,platelet count and prothrombin time(P<0.05).Distal skull fracture,history of anticoagulation,hydrocephalus,DTIH,PADBS,and preoperative intracranial pressure are all risk factors for postoperative encephalocele in patients with severe TBI(P<0.05);the results of the nomogram model showed that the model consistency index was 0.857(95%CI:0.823-0.891),the calibration curve was basically consistent with the ideal curve,and the area under the receiver operating characteristic curve was 0.848(95%CI:0.817-0.879).Conclusion Combination of surgically distant skull fractures,history of anticoagulation,hydrocephalus,DTIH,PADBS,and preoperative intracranial pressure are independent risk facto

关 键 词：重型颅脑损伤 脑膨出 危险因素 预测模型 

分 类 号：R651.15[医药卫生—外科学]