ICU自发性脑出血患者再出血的风险预测列线图模型构建  

Construction of a nomogram model for risk prediction of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU

作　　者：顾君玲[1] 倪敏[1] 宗海燕[1] 何平[1] 张燕[1] 鲁晓杰[1] Gu Junling;Ni Min;Zong Haiyan;He Ping;Zhang Yan;Lu Xiaojie(Department of Critical Medicine,North Hospital,Wuxi Second People's Hospital,Wuxi 214000,China)

机构地区：[1]无锡市第二人民医院北院重症医学科,无锡214000

出　　处：《国际医药卫生导报》2024年第2期228-234,共7页International Medicine and Health Guidance News

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2020R0003)。

摘　　要：目的探讨重症监护室(ICU)自发性脑出血患者再出血的影响因素,并依此建立列线图预测模型。方法回顾性分析2019年6月至2022年6月无锡市第二人民医院收治的173例ICU自发性脑出血患者的临床资料,根据患者有无再出血将其分为再出血组(38例)和未再出血组(135例)。比较两组患者一般资料,采用多因素logistic回归分析法分析ICU自发性脑出血患者再出血的影响因素,并采用R3.4.3软件包绘制列线图模型,另绘制受试者操作特征曲线(ROC)以评估列线图模型的预测效能,绘制校准曲线图评估列线图的区分度,采用Bootstrap法检验预测列线图模型的一致性。采用t检验、χ^(2)检验。结果再出血组男24例、女14例,年龄(61.57±7.53)岁;未再出血组男75例、女60例,年龄(59.08±7.39)岁。两组患者性别、年龄、体质量指数(BMI)、吸烟史、饮酒史、糖尿病史、病因分型、格拉斯哥昏迷量表(GCS)评分、血肿形状、血肿位置、出血量、手术方式、术前收缩压、术前舒张压、术前血小板计数、术后使用止血药比较,差异均无统计学意义(均P>0.05);再出血组长期使用抗凝药、血肿密度不均匀、手术时机3~6 h、术后血压控制不理想、术后躁动占比及术前血糖、术前D-二聚体水平均高于未再出血组[47.37%(18/38)比24.44%(33/135)、71.05%(27/38)比43.70%(59/135)、31.58%(12/38)比10.37%(14/135)、18.42%(7/38)比2.96%(4/135)、42.11%(16/38)比22.96%(31/135)、(6.39±1.02)mmol/L比(5.95±1.25)mmol/L、(0.51±0.04)mg/L比(0.43±0.05)mg/L],差异均有统计学意义(χ^(2)=7.496、8.872、10.476、12.924、5.491,t=1.990、9.073;均P<0.05)。多因素logistic回归分析显示,长期使用抗凝药、血肿密度不均匀、手术时机为3~6 h、术前D-二聚体水平升高、术后血压控制不理想、术后躁动均是ICU自发性脑出血患者再出血的危险因素(均P<0.05)。ROC分析结果显示,列线图预测ICU自发性脑出血患者再出血�Objective To investigate the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in intensive care unit(ICU),and to establish a nomogram prediction model.Methods The clinical data of 173 patients with spontaneous cerebral hemorrhage in ICU of Wuxi Second People's Hospital from June 2019 to June 2022 were retrospectively analyzed.According to whether the patients had rebleeding or not,they were divided into a rebleeding group(38 cases)and a non-rebleeding group(135 cases).The general data of the two groups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU.R3.4.3 software package was used to draw the nomogram model,and the receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficacy of the nomogram model.The calibration curve was drawn to evaluate the discrimination of the nomogram model,and the Bootstrap method was used to test the consistency of the prediction nomogram model.t test andχ^(2) test were used.Results In the rebleeding group,there were 24 males and 14 females,aged(61.57±7.53)years.In the non-rebleeding group,there were 75 males and 60 females,aged(59.08±7.39)years.There were no statistically significant differences in the gender,age,body mass index(BMI),smoking history,drinking history,diabetes history,etiology classification,Glasgow Coma Scale(GCS)score,hematoma shape,hematoma location,bleeding volume,operation mode,preoperative systolic blood pressure,preoperative diastolic blood pressure,preoperative platelet count,and postoperative use of hemostatic drugs between the rebleeding group and the non-rebleeding group(all P>0.05).In the rebleeding group,the ratios of long-term use of anticoagulants,uneven hematoma density,operation timing of 3-6 h,unsatisfactory postoperative blood pressure control,and postoperative agitation and levels of preoperative blood glucose and preoperative D-dimer were higher than those

关 键 词：重症监护室 自发性脑出血 再出血 列线图 预测模型 

分 类 号：R743.34[医药卫生—神经病学与精神病学]