中线移位程度对硬膜下血肿患者钻孔引流术后大面积脑梗死预测  

The degree of midline shift in predicting massive cerebral infarction after drilling drainage of subdural hematoma patients

作　　者：吴蔚 Wu Wei(Sixth Ward,Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,黑龙江150001

出　　处：《脑与神经疾病杂志》2025年第4期217-223,共7页Journal of Brain and Nervous Diseases

摘　　要：目的探究中线移位程度对硬膜下血肿(SDH)患者钻孔引流术后大面积脑梗死(MCI)预测作用。方法选择2021年5月至2024年5月于哈尔滨医科大学附属第一医院神经外科行钻孔引流术的SDH患者340例为研究对象,根据术后随访是否继发MCI分为无MCI组(n=238)和MCI组(n=102)。比较两组临床资料和计算机断层扫描(CT)影像学特征。采用分层回归模型分析其他因素与中线移位程度的关系。分别在纳入或不纳入中线移位程度的情况下,多因素Logistic回归分析术后MCI的独立危险因素,基于此构建术后MCI预测模型。通过受试者工作特征曲线下面积(AUC-ROC)、综合判别改善指数(IDI)和净重新分类指数(NRI)比较不同模型的预测效能;Hosmer-Lemeshow检验比较不同模型的拟合优度。采用限制性立方样条及阈值效应分析中线移位程度与术后MCI的关系。结果与无MCI组比较,MCI组格拉斯哥昏迷量表(GCS)评分显著降低(P<0.05),年龄、病程、Markwalder分级、美国国立卫生研究院卒中量表(NIHSS)评分以及血肿体积、血肿宽度、分隔型血肿、中线移位程度显著增加(P<0.05)。分层回归分析结果显示,年龄、NIHSS评分、血肿体积、血肿宽度会对中线移位程度产生正向影响关系(P<0.05)。不含中线移位程度的多因素Logistic回归分析结果显示,年龄、病程、NIHSS评分、血肿体积、血肿宽度、分隔型血肿是术后MCI的独立危险因素,据此构建预测模型1;加入中线移位程度的多因素Logistic回归分析结果显示,术后MCI的独立危险因素包括年龄、NIHSS评分、血肿体积、血肿宽度、血肿类型、中线移位程度,据此构建预测模型2。模型1加入中线移位程度后AUC-ROC(0.812,95%CI:0.798~0.845)、IDI(0.081,95%CI:0.052~0.105)和NRI(0.617,95%CI:0.531~0.684)显著提高(P<0.05)。与模型1比较,模型2的AUC-ROC(0.805,95%CI:0.785~0.837)、IDI(0.078,95%CI:0.049~0.096)、NRI(0.603,95%CI:0.527~0.671)显著提高Objective To investigate the predictive effect of midline shift degree on massive cerebral infarction(MCI)in patients with subdural hematoma(SDH)after drilling drainage.Methods A total of 340 patients with SDH who underwent drilling drainage in First Affiliated Hospital of Harbin Medical University from May2021 to May 2024 were selected as the study objects,according to the postoperative follow-up,they were divided into MCI free group(n=238)and MCI group(n=102).The clinical data and computed tomography(CT)imaging features of the two groups were compared.Hierarchical regression model was used to analyze the relationship between other factors and the degree of midline shift.Multivariate Logistic regression was used to analyze the independent risk factors of postoperative MCI with or without the degree of midline shift,and based on this,the postoperative MCI prediction models were constructed.The prediction efficiency of different models was compared by area under receiver operating characteristic curve(AUC-ROC),integrated discrimination improvement(IDI)and net reclassification improvement(NRI).The Hosmer-Lemeshow test was used to compare the goodness of fit of different models.The relationship between the degree of midline shift and postoperative MCI was analyzed with restricted cubic splines and threshold effects.Results Compared with the group without MCI,glasgow coma scale(GCS)score in MCI group was significantly decreased(P<0.05),while age,course of disease,markwalder grade,national institutes of health stroke scale(NIHSS)score,hematoma volume,hematoma width,separated hematoma and midline displacement degree were significantly increased(P<0.05).Stratified regression analysis showed that age,NIHSS score,hematoma volume and hematoma width had positive effects on the degree of midline shift(P<0.05).Multivariate Logistic regression analysis without the degree of midline shift showed that age,course of disease,NIHSS score,hematoma volume,hematoma width,and separated hematoma were independent risk factors for postope

关 键 词：中线移位 硬膜下血肿 钻孔引流术 大面积脑梗死 预测 

分 类 号：R743[医药卫生—神经病学与精神病学]