急性硬膜下血肿患者围术期继发颅内高压的Cox比例风险预测模型的建立及评价  

Establishment and evaluation of Cox proportional-hazards prediction model for secondary intracranial hypertension in perioperative period in patients with acute subdural hematoma

作　　者：童凌霄 秦虎[2] 闫宝锋 TONG Lingxiao;QIN Hu;YAN Baofeng(Neurosurgery Department,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830063;Neurosurgery Department,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830000)

机构地区：[1]新疆医科大学第二附属医院神经外科,新疆乌鲁木齐830063 [2]新疆医科大学第一附属医院神经外科,新疆乌鲁木齐830000

出　　处：《实用临床医药杂志》2024年第13期36-40,57,共6页Journal of Clinical Medicine in Practice

基　　金：自治区重点实验室新疆神经系统疾病研究重点实验室开放课题项目(XJDX1711-2114)。

摘　　要：目的构建急性硬膜下血肿(ASDH)患者围术期继发颅内高压的Cox比例风险预测模型,并对其效能进行验证。方法回顾性收集78例ASDH患者的临床资料,按围术期继发颅内高压情况将其分为继发组(25例,围术期继发颅内高压)和对照组(53例,围术期未继发颅内高压)。比较2组患者人口统计学指标、合并症、临床生化指标及影像学资料等因素的差异。应用Cox比例风险模型对ASDH患者围术期继发颅内高压的可能影响因素进行多因素分析。建立ASDH患者围术期继发颅内高压的预测模型并测算Harrell′s C指数以评估模型预测的准确度。通过列线图及校准曲线评估该模型预测风险概率与实际风险概率的符合程度。结果全组半年随访率为89.74%(70/78)。继发组年龄、吸烟史、高血压病、糖尿病、术前格拉斯哥昏迷量表(GCS)评分、格拉斯哥预后量表(GOS)评分、复合型血肿、颅内血肿体积、平均动脉压、糖化血红蛋白(HbA1c)、国际标准化比值(INR)、白细胞介素-6(IL-6)、降钙素原(PCT)与对照组比较,差异有统计学意义(P<0.05)。年龄(OR=2.895,95%CI:1.264~6.633,P=0.022)、吸烟史(OR=2.146,95%CI:1.029~4.475,P=0.036)、GOS评分(OR=0.288,95%CI:0.112~0.741,P=0.015)、HbA1c(OR=3.325,95%CI:1.243~8.894,P=0.028)、INR(OR=2.746,95%CI:1.203~6.267,P=0.027)、PCT(OR=3.426,95%CI:1.335~8.795,P=0.019)是ASDH患者围术期继发颅内高压的独立影响因素,Harrell′s C指数为0.812(95%CI:0.789~0.872)。列线图及校准曲线显示实际风险与模型预测风险存在较好的一致性。结论急性硬膜下血肿患者的Cox比例风险模型预测围术期继发颅内高压风险的准确度高,适宜临床推广。Objective To construct a Cox proportional hazards prediction model for secondary intracranial hypertension in patients with acute subdural hematoma(ASDH)during the perioperative period and validate its effectiveness.Methods Clinical data of 78 patients with ASDH were retrospectively collected and divided into secondary group(25 cases with secondary intracranial hypertension during perioperation)and control group(53 cases without secondary intracranial hypertension during perioperation).Differences in demographic indicators,comorbidities,clinical biochemical indicators,and imaging data between the two groups were compared.The Cox proportional hazards model was used to perform a multivariate analysis of independent risk factors that may affect secondary intracranial hypertension in ASDH patients during the perioperative period.A prediction model for secondary intracranial hypertension in ASDH patients during the perioperative period was established,and Harrell′s C index was calculated to assess the predictive accuracy of the model.The degree of agreement between the model prediction and actual risks was evaluated through a nomogram and calibration curve.Results The six-month follow-up rate was 89.74%(70/78).Age,smoking history,hypertension,diabetes,preoperative Glasgow Coma Scale(GCS)score,Glasgow Outcome Scale(GOS)score,complex hematoma,intracranial hematoma volume,mean arterial pressure,glycated hemoglobin(HbA1c),international normalized ratio(INR),interleukin-6(IL-6),and procalcitonin(PCT)in the secondary group showed statistically significant differences compared with the control group(P<0.05).Age(OR=2.895;95%CI,1.264 to 6.633;P=0.022),smoking history(OR=2.146;95%CI,1.029 to 4.475;P=0.036),GOS score(OR=0.288;95%CI,0.112 to 0.741;P=0.015),HbA1c(OR=3.325;95%CI,1.243 to 8.894;P=0.028),INR(OR=2.746;95%CI,1.203 to 6.267;P=0.027),and PCT(OR=3.426;95%CI,1.335 to 8.795;P=0.019)were independent influencing factors for secondary intracranial hypertension in ASDH patients during the perioperative period.Harrell′s C in

关 键 词：急性硬膜下血肿 颅内高压 危险因素 COX比例风险模型 

分 类 号：R651.1[医药卫生—外科学] R195.1[医药卫生—临床医学] R619