颅脑外伤患者去骨瓣减压术后短期内新发出血多指标联合预警模型的构建与验证  

Construction and validation of a new multi-index warning model for new hemorrhage in the short term after decompressive craniectomy in patients with craniocerebral trauma

作　　者：贾振岭[1] 徐冬静 李佳 单玉超 李静[1] JIA Zhenling;XU Dongjing;LI Jia;SHAN Yuchao;LI Jing(Baoding NO.1 Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院,河北保定071000

出　　处：《中国实用神经疾病杂志》2025年第3期284-288,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河北省2020年度医学科学研究课题计划项目(编号:20200172);保定市科技计划项目(编号:2341ZF156)。

摘　　要：目的构建并验证颅脑外伤患者去骨瓣减压术后短期内新发出血多指标联合预警模型及对预后的影响。方法依据术后24 h内新发出血情况,将2022-01—2023-11于保定市第一中心医院行去骨瓣减压术的125例颅脑外伤患者分为出血组、未出血组,比较2组临床资料。采用Logistic多因素回归分析法筛选影响颅脑外伤患者去骨瓣减压术后短期内新发出血的危险因素,基于上述危险因素构建颅脑外伤患者去骨瓣减压术后短期内新发出血预测列线图模型,并验证该模型的准确性。术后随访3个月,依据格拉斯哥预后量表(GOS)评估患者预后。结果颅脑外伤去骨瓣减压术后短期新发出血率约为31.20%(39/125)。与未出血组比较,出血组患者合并糖尿病、术前Rotterdam CT评分>3分、伴硬膜下血肿、血肿量≥30 mL、合并颅骨骨折占比及D-二聚体(D-D)水平较高,凝血酶时间(TT)较长,纤维蛋白原(FIB)水平较低,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,合并糖尿病(OR=1.822,95%CI:1.605~2.615)、术前Rotterdam CT评分>3分(OR=1.816,95%CI:1.619~2.594)、伴硬膜下血肿(OR=1.854,95%CI:1.637~2.738)、血肿量≥30 mL(OR=1.865,95%CI:1.684~2.749)、合并颅骨骨折(OR=1.914,95%CI:1.658~2.815)、TT长(OR=1.825,95%CI:1.605~2.635)是影响颅脑外伤去骨瓣减压术后短期新发出血的独立危险因素。基于合并糖尿病、术前Rotterdam CT评分>3分、伴硬膜下血肿、血肿量≥30 mL、合并颅骨骨折、TT构建的颅脑外伤去骨瓣减压术后短期新发出血预测列线图模型C-index为0.895(95%CI:0.757~0.942)。随访发现,2组均无死亡病例,非出血组术后3个月GOS分级优于出血组(P<0.05),其中Ⅴ级率约为58.14%(50/86)。结论合并糖尿病、术前Rotterdam CT评分>3分、伴硬膜下血肿、血肿量≥30 mL、合并颅骨骨折、TT长是影响颅脑外伤去骨瓣减压术后短期新发出血的危险因素,据此建立的多指标联合预�Objective To construct and verify a new multi-index combined warning model for new hemorrhage in the short term after decompressive craniectomy in patients with craniocerebral trauma and its influence on the prognosis.Methods According to the new hemorrhage within 24 h after surgery,125 patients with craniocerebral trauma who underwent decompressive craniectomy in Baoding NO.1 Central Hospital from January 2022 to November 2023 were divided into the bleeding group and the non-bleeding group,and the clinical data of the two groups were compared.Logistic multivariate regression analysis was used to screen the risk factors for new hemorrhage in the short term after craniocerebral trauma,based on the above risk factors,a new blood flow prediction model for craniocerebral trauma patients after craniocerebral decompression was constructed,and the accuracy of this model was verified.The patients were followed up for 3 months after surgery and the prognosis was assessed according to Glasgow outcome scale(GOS).Results The rate of new hemorrhage after craniocerebral injury was 31.20%(39/125).Compared with the non-bleeding group,the bleeding combination with diabetes mellitus,preoperative Rotterdam CT score>3,subdural hematoma,hematoma volume≥30 mL,skull fracture,D-dimer(D-D)level were higher,thrombin time(TT)was longer,and fibrinogen(FIB)level was lower,the differences between both groups was statistically significant(P<0.05).Logistic multivariate regression analysis showed that patients with diabetes mellitus(OR=1.822,95%CI:1.605-2.615)and preoperative Rotterdam CT score>3(OR=1.816,95%CI:1.619-2.594),accompanied by subdural hematoma(OR=1.854,95%CI:1.637-2.738),hematoma volume≥30 mL(OR=1.865,95%CI:1.684-2.749),combined with skull fracture(OR=1.914,95%CI:1.658-2.815)and TT length(OR=1.825,95%CI:1.605-2.635)were independent risk factors for short-term new hemorrhage after craniocerebral injury craniectomy.Based on the preoperative Rotterdam CT score>3,subdural hematoma,hematoma volume≥30 mL,skull fracture and TT,the sh

关 键 词：颅脑外伤 去骨瓣减压术 术后新发出血 预警模型 预后 危险因素 

分 类 号：R445.3[医药卫生—影像医学与核医学] R651.15[医药卫生—诊断学]