神经重症脑卒中术后呼吸衰竭风险预测列线图模型的构建与验证  

Construction and verification of a nomogram model for predicting the risk of postoperative respiratory failure in patients with severe neurological stroke

作　　者：李云云 周慧玲 许菊芳[2] 韩雯雯 王妮 聂玉琴[3] LI Yunyun;ZHOU Huiling;XU Jufang;HAN Wenwen;WANG Ni;NIE Yuqin(School of Nursing,Xinjiang Medical University,Urumqi,Xinjiang 830011,China;Department of Neurosurgery,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830018,China;Department of Nursing,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830018,China)

机构地区：[1]新疆医科大学护理学院,乌鲁木齐830011 [2]新疆医科大学第二附属医院神经外科,乌鲁木齐830018 [3]新疆医科大学第二附属医院护理部,乌鲁木齐830018

出　　处：《重庆医学》2023年第20期3104-3109,共6页Chongqing medicine

基　　金：新疆神经系统疾病研究重点实验室(XJDX1711-2106)。

摘　　要：目的分析神经重症脑卒中术后呼吸衰竭的危险因素,构建风险预测模型并验证。方法选取新疆医科大学第二附属医院神经重症急性脑卒中需行手术治疗的患者338例,其中建模组237例,验证组101例,分析神经重症急性脑卒中患者术后呼吸衰竭发生的危险因素并构建列线图模型,采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线分析(DCA)评估列线图预测模型的区分度、校准度和临床实用性。结果年龄增长(OR=1.025,95%CI:>1.000~1.051,P=0.049)、有合并呼吸系统疾病史(OR=6.155,95%CI:2.841~13.332,P<0.001)、气管插管机械通气(OR=49.415,95%CI:9.944~245.567,P<0.001)、误吸风险(OR=13.134,95%CI:5.320~32.429,P<0.001)及血乳酸升高(OR=1.657,95%CI:1.087~2.526,P=0.019)是神经重症脑卒中术后发生呼吸衰竭的独立危险因素。ROC曲线表明,建模组ROC曲线下面积(AUC)及其95%CI为0.885(0.840~0.930),验证组AUC及其95%CI为0.906(0.839~0.972)。校准曲线和DCA曲线同样显示列线图具有良好的精准性和临床实用性。结论构建的列线图模型能有效预测神经重症脑卒中患者术后呼吸衰竭发生风险,可为神经重症脑卒中术后预防呼吸衰竭提供参考。Objective To explore the risk factors of postoperative respiratory failure in patients with severe neurological stroke,and to construct and verify the risk prediction model.Methods A total of 338 patients with severe acute stroke requiring surgical treatment in the Second Affiliated Hospital of Xinjiang Medical University were selected,including 237 patients in the modeling group and 101 patients in the verification group.The risk factors of postoperative respiratory failure in patients with severe acute stroke were analyzed,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve analysis(DCA)were used to evaluate the discrimination,calibration and clinical practicability of the nomogram prediction model.Results Increasing age(OR=1.025,95%CI:>1.000-1.051,P=0.049),history of respiratory diseases(OR=6.155,95%CI:2.841-13.332,P<0.001),mechanical ventilation for endotracheal intubation(OR=49.415,95%CI:9.944-245.567,P<0.001),risk of aspiration(OR=13.134,95%CI:5.320-32.429,P<0.001),and elevated blood lactic acid(OR=1.657,95%CI:1.087-2.526,P=0.019)were independent risk factors of postoperative respiratory failure in patients with severe neurological stroke.The ROC curve showed that the area under the ROC curve(AUC)and 95%CI of the modeling group were 0.885(0.840-0.930),and the AUC and 95%CI of the validation group were 0.906(0.839-0.972).The calibration curve and DCA curve also showed that the nomogram had good accuracy and clinical practicability.Conclusion The constructed nomogram model can effectively predict the risk of postoperative respiratory failure in patients with severe neurological stroke,and provide references for the prevention of postoperative respiratory failure in patients with severe neurological stroke.

关 键 词：脑卒中 术后 呼吸衰竭 预测模型 列线图 

分 类 号：R651.1[医药卫生—外科学] R563[医药卫生—临床医学]