摘要
目的在确认创伤性颈脊髓损伤(TCSCI)气管切开的危险因素的基础上,构建分类与回归树(CART)模型以指导气管切开。方法回顾性分析2009年1月至2018年12月陆军军医大学新桥医院骨科收治的498例TCSCI患者资料,男403例,女86例;年龄(50.2±13.6)岁。其中气管切开69例,未行气管切开420例。统计患者的性别、年龄、吸烟史、致伤原因、神经损伤平面(NLI)、美国脊髓损伤学会(ASIA)分级、创伤严重程度评分(ISS)、胸部损伤、既往肺部疾病、既往基础疾病、手术入路并进行单因素分析。通过二元logistic回归分析行气管切开的危险因素,并在危险因素的基础上建立预测气管切开的CART。结果logistic回归分析显示,年龄>50岁(OR=4.744,95%CI:1.802~12.493,P=0.002)、NLI在C_(4)及以上(OR=23.662,95%CI:8.449~66.268,P<0.001)、ASIA分级A级(OR=40.007,95%CI:12.992~123.193,P<0.001)及ISS>16分(OR=10.502,95%CI:3.909~28.211,P<0.001)是行气管切开的危险因素。CART显示,ASIA分级A级、神经损伤平面在C_(4)及以上作为第一、第二决策点对行气管切开具有较强的预测作用,ASIA分级A级且神经损伤平面在C_(4)及以上的TCSCI患者行气管切开的比例为86.84%。结论CART模型结果显示神经损伤平面在C_(4)及以上、ASIA分级A级对气管切开具有较强的指导作用。
Objective To construct a classification and regression tree which can be used to guide the tracheostomy for traumatic cervical spinal cord injury(TCSCI)based on the identification of the risk factors for TCSCI.Methods The 498 patients with TCSCI were retrospectively analyzed who had been treated at Department of Orthopedics,The Second Hospital Affiliated to Army Medical University from January 2009 to December 2018.There were 403 males and 86 females,with an age of(50.2±13.6)years.Of the patients,69 received tracheostomy and 420 did not.The gender,age,smoking history,injury cause,neurological level of injury(NLI),American Spinal Cord Injury Association(ASIA)grade,injury severity score(ISS),thoracic injuries,prior pulmonary diseases,prior basic diseases,and operative approaches of the patients were statistically analyzed by single factor analysis.After the independent risk factors for tracheostomy were analyzed by binary logistic regression,the classification and regression tree was developed which could be used to guide the tracheostomy.Results The logistic regression analysis showed age>50 years(OR=4.744,95%CI:1.802 to 12.493,P=0.002),NLI at C_(4) and above(OR=23.662,95%CI:8.449 to 66.268,P<0.001),ASIA grade A(OR=40.007,95%CI:12.992 to 123.193,P<0.001),and ISS score>16(OR=10.502,95%CI:3.909 to 28.211,P<0.001)were the independent risk factors for the tracheotomy.The classification and regression tree revealed that ASIA grade A and NLI at C_(4) and above were the first and second decision nodes,which had a strong predictive effect on tracheostomy.86.84%of the patients with ASIA grade A and NLI at C_(4) and above underwent tracheostomy.Conclusion Our classification and regression tree shows that NLI at C_(4) and above and ASIA grade A have a strong guiding effect on tracheotomy for TCSCI.
作者
孙大卫
穆智平
孙晨曦
聂丕明
简云波
赵汉青
张正丰
Sun Dawei;Mu Zhiping;Sun Chenxi;Nie Piming;Jian Yunbo;Zhao Hanqing;Zhang Zhengfeng(Department of Orthopedics,The Second Hospital Affiliated to Army Medical University,Chongqing 400037,China;71 Army Hospital,Xuzhou 221000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2023年第1期51-57,共7页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金(81572210)。
关键词
脊髓损伤
气管切开术
危险因素
分类与回归树模型
预测
Spinal cord injury
Tracheostomy
Risk factors
Classification and regression trees
Prediction
