摘要
目的探讨影响成人创伤性脑损伤(TBI)患者预后的危险因素,构建TBI预后模型并对其预测价值进行评估。方法采用病例对照研究分析2011年3月至2019年9月空军军医大学西京医院收治的522例TBI患者临床资料,其中男438例,女84例;年龄18~75岁[(44.9±15.0)岁]。根据患者出院时格拉斯哥预后评分(GOS)分为预后良好组(GOS 4~5分,165例)和预后不良组(GOS 1~3分,357例)。比较两组患者的定性资料如性别、基础性疾病、伤因、多发伤、开放伤、颅内异物、脑疝、出入院意识状态、手术、入院肺部感染、气管切开、呼吸机辅助通气、院内获得性肺炎及致病菌、颅内感染,以及定量资料如出入院格拉斯哥昏迷评分(GCS)、年龄,入院收缩压、舒张压、平均动脉压、体温、心率、肌酐、尿素氮、血钠、血钾、血糖、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板、国际标准化比值(INR)、双眼瞳孔大小,住院时间。采用单因素分析及Lasso回归分析筛选影响TBI患者预后的危险因素,将筛选出的影响因素纳入多因素Logistic回归分析,分析独立危险因素并构建回归方程。应用R语言绘制基于回归方程的针对预测TBI患者预后的可视化列线图模型。采用受试者工作特征(ROC)曲线对该列线图的预后预测价值进行评价,计算曲线下面积(AUC)、Youden指数、灵敏度、特异度及一致性指数(C指数)。结果单因素分析结果显示,两组基础性疾病、开放伤、脑疝、出入院意识状态、入院肺部感染、气管切开、呼吸机辅助通气、院内获得性肺炎及致病菌、出入院GCS、年龄、入院收缩压、平均动脉压、体温、心率、肌酐、尿素氮、血钾、血糖、PT、INR、右眼瞳孔大小等指标差异有统计学意义(P<0.05或0.01)。两组性别、伤因、多发伤、颅内异物、手术、颅内感染、入院舒张压、血钠、APTT、血小板、左眼瞳孔大小及住
Objective To analyze risk factors for prognosis of adult patients with traumatic brain injury(TBI),construct the prognostic model of TBI and evaluate its predictive value.Methods A case-control study was used to analyze the clinical data of 522 patients with TBI admitted to Xijing Hospital of Air Force Medical University from March 2011 to September 2019,including 438 males and 84 females;aged 18-75 years[(44.9±15.0)years].According to the Glasgow outcome score(GOS)at discharge,the patients were divided into good prognosis group(GOS 4-5 points,n=165)and poor prognosis group(GOS 1-3 points,n=357).The two groups were compared with regards to qualitative data such as sex,underlying diseases,causes of injury,multiple injuries,open injuries,intracranial foreign bodies,cerebral herniation,consciousness status on admission and at discharge,surgery,lung infection on admission,tracheostomy,ventilator-assisted ventilation,hospital-acquired pneumonia/pathogenic bacteria and intracranial infection,and quantitative data such as Glasgow coma score(GCS)on admission and at discharge,age,measurements on admission[systolic blood pressure,diastolic blood pressure,mean arterial pressure,temperature,heart rate,creatinine,urea nitrogen,blood sodium,blood potassium,blood glucose,prothrombin time(PT),activated partial thromboplastin time(APTT),platelets,international normalized ratio(INR),pupil size of both eyes]and length of hospital stay.Univariate analysis and Lasso regression analysis were used to screen the risk factors affecting the prognosis of TBI patients,and the selected influencing factors were included in multivariate Logistic regression analysis to identify independent risk factors and construct regression equations.R was used to draw a visual nomogram based on regression equation for predicting the prognosis of TBI patients.The prognostic predictive value of the nomogram was evaluated by using the receiver operating characteristic(ROC)curve,and the area under the curve(AUC),Youden index,sensitivity,specificity and consist
作者
包明冬
葛俊苗
杨秋子
孙季冬
武秀权
蒋晓帆
罗鹏
Bao Mingdong;Ge Junmiao;Yang Qiuzi;Sun Jidong;Wu Xiuquan;Jiang Xiaofan;Luo Peng(Department of Neurosurgery,Xijing Hospital of Air Force Medical University,Xi'an 710032,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第3期229-237,共9页
Chinese Journal of Trauma
基金
国家自然科学基金(82171363,82171458)
陕西省青年科技新星项目(2021KJXX‑19)。
