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中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (02) : 96 -102. doi: 10.3877/cma.j.issn.2095-123X.2022.02.007

临床研究

重型颅脑损伤患者术后脑膨出的影响因素及风险预测模型的构建
张华1, 刘广明1,()   
  1. 1. 611730 成都,郫都区人民医院重症医学科
  • 收稿日期:2022-01-20 出版日期:2022-04-15
  • 通信作者: 刘广明

Influencing factors of postoperative encephalocele in patients with severe craniocerebral injury and construction of risk prediction model

Hua Zhang1, Guangming Liu1,()   

  1. 1. Department of Critical Medicine, Pidu District People’s Hospital, Chengdu 611730, China
  • Received:2022-01-20 Published:2022-04-15
  • Corresponding author: Guangming Liu
引用本文:

张华, 刘广明. 重型颅脑损伤患者术后脑膨出的影响因素及风险预测模型的构建[J/OL]. 中华脑科疾病与康复杂志(电子版), 2022, 12(02): 96-102.

Hua Zhang, Guangming Liu. Influencing factors of postoperative encephalocele in patients with severe craniocerebral injury and construction of risk prediction model[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(02): 96-102.

目的

探讨重型颅脑损伤(TBI)患者术后发生脑膨出的影响因素,并建立重型TBI患者术后发生脑膨出风险预测模型。

方法

选择郫都区人民医院重症医学科自2018年1月至2020年2月收治的126例重型TBI患者为研究对象,根据术后脑膨出发生与否,分为脑膨出组和非脑膨出组。收集2组患者一般临床资料,采用单因素及多因素分析重型TBI患者术后发生脑膨出的危险因素,采用R(R3.5.3)建立预测重型TBI患者术后发生脑膨出的风险列线图模型。

结果

脑膨出组患者42例,脑膨出发生率为33.33%(42/126),非脑膨出组84例。单因素分析结果显示,手术远隔部位颅骨骨折、抗凝药物服用史、脑积水、颅内感染、迟发性外伤性颅内血肿(DTIH)、外伤性弥漫性脑肿胀(PADBS)、术前颅内压、血小板计数以及凝血酶原时间是术后脑膨出的影响因素(P<0.05)。多因素Logistic回归分析结果显示,合并手术远隔部位颅骨骨折、抗凝药物服用史、脑积水、DTIH、PADBS以及术前颅内压均为重型TBI患者术后发生脑膨出的危险因素(P<0.05)。列线图模型结果显示,模型一致性指数为0.857(95%CI:0.823~0.891),校正曲线与理想曲线基本一致,受试者工作特征曲线下面积为0.848(95%CI:0.817~0.879)。

结论

合并手术远隔部位颅骨骨折、伴有抗凝药物服用史、伴有脑积水、合并DTIH、合并PADBS以及术前颅内压均为重型TBI患者术后发生脑膨出的独立危险因素,基于上述6项危险因素所建立的风险预测模型有助于预测重型TBI患者术后脑膨出的发生风险。

Objective

To investigate the influencing factors of postoperative encephalocele in patients with severe traumatic brain injury (TBI), and to establish a risk prediction model for postoperative encephalocele in patients with severe TBI.

Methods

A total of 126 patients with severe TBI who were treated in Critical Medicine Department of Pidu District People’s Hospital from January 2018 to February 2020 were selected as the research objects. According to the occurrence of postoperative encephalocele, they were divided into encephalocele group and non encephalocele group. The general clinical data of the two groups were collected, and the risk factors of postoperative encephalocele in patients with severe TBI were analyzed by univariate and multivariate factors. R (R3.5.3) was used to establish a nomographic model for predicting the risk of encephalocele in patients with severe TBI after surgery.

Results

There were 42 patients in the encephalocele group, the incidence of encephalocele was 33.33% (42/126), and 84 patients in the non-encephalocele group. Univariate analysis showed that the influencing factors of postoperative encephalocele were distal skull fracture, history of anticoagulation, hydrocephalus, intracranial infection, delayed traumatic intracranial hematoma (DTIH), post-traumatic acute diffuse brain swelling (PADBS), preoperative intracranial pressure, platelet count and prothrombin time (P<0.05). Distal skull fracture, history of anticoagulation, hydrocephalus, DTIH, PADBS, and preoperative intracranial pressure are all risk factors for postoperative encephalocele in patients with severe TBI (P<0.05); the results of the nomogram model showed that the model consistency index was 0.857 (95%CI: 0.823-0.891), the calibration curve was basically consistent with the ideal curve, and the area under the receiver operating characteristic curve was 0.848 (95%CI: 0.817-0.879).

Conclusion

Combination of surgically distant skull fractures, history of anticoagulation, hydrocephalus, DTIH, PADBS, and preoperative intracranial pressure are independent risk factors for postoperative encephalocele in patients with severe TBI. The risk prediction model established by the above six risk factors can help predict the risk of postoperative encephalocele in patients with severe TBI.

表1 重型TBI患者术后发生脑膨出的单因素分析
表2 变量赋值表
表3 重型TBI患者术后发生脑膨出的多因素Logistic回归分析
图1 重型颅脑损伤患者术后发生脑膨出的风险列线图预警模型 DTIH:迟发性外伤性颅内血肿;PADBS:外伤性弥漫性脑肿胀;1 mmHg=0.133 kPa
图2 重型颅脑损伤患者术后并发脑膨出的列线图模型的校正曲线检验
图3 列线图模型的受试者工作特征曲线验证
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