[1]唐知己,李 卫,黄乾亮,等.重型颅脑创伤急诊去骨瓣减压手术临床预后预测模型的开发及验证评价[J].医学信息,2024,37(18):25-30.[doi:10.3969/j.issn.1006-1959.2024.18.005]
　TANG Zhi-ji,LI Wei,HUANG Qian-liang,et al.Development and Validation Evaluation of Clinical Prognosis Prediction Model for Emergency Decompressive Craniectomy in Severe Traumatic Brain Injury[J].Journal of Medical Information,2024,37(18):25-30.[doi:10.3969/j.issn.1006-1959.2024.18.005]
点击复制

重型颅脑创伤急诊去骨瓣减压手术临床预后预测模型的开发及验证评价()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年18期
页码:
25-30
栏目:
临床信息学
出版日期:
2024-09-15

文章信息/Info

Title:
Development and Validation Evaluation of Clinical Prognosis Prediction Model for Emergency Decompressive Craniectomy in Severe Traumatic Brain Injury
文章编号:
1006-1959（2024）18-0025-06
作者:
唐知己1; 李 卫1; 黄乾亮1; 钟 鸣2; 何晓明3; 王乐临4; 曾瑞亮5
1.赣州市人民医院神经外科，江西 赣州 341000；2.会昌县人民医院神经外科，江西 会昌 342600；3.上犹县人民医院神经外科，江西 上犹 341200；4.宁都县人民医院神经外科，江西 宁都 342800；5.瑞金市人民医院神经外科，江西 瑞金 342500
Author(s):
TANG Zhi-ji1; LI Wei1; HUANG Qian-liang1; ZHONG Ming2; HE Xiao-ming3; WANG Le-lin4; ZENG Rui-liang5
1.Department of Neurosurgery,Ganzhou People’s Hospital,Ganzhou 341000,Jiangxi,China;2.Department of Neurosurgery,Huichang County People’s Hospital,Huichang 342600,Jiangxi,China;3.Department of Neurosurgery,Shangyou County People’s Hospital,Shangyou 341200,Jiangxi,China;4.Department of Neurosurgery,Ningdu County People’s Hospital,Ningdu 342800,Jiangxi,China;5.Department of Neurosurgery,Ruijin People’s Hospital,Ruijin 342500,Jiangxi,China
关键词:
颅脑创伤; 去骨瓣减压; 危险因素; 预测模型
Keywords:
Traumatic brain injury; Decompressive craniectomy; Risk factors; Prediction model
分类号:
R651.1+5
DOI:
10.3969/j.issn.1006-1959.2024.18.005
摘要:
目的 构建重型颅脑损伤患者急诊行去骨瓣减压的预后预测模型并进行评价和验证。方法 对2015年1月-2021年1月在赣州市人民医院等5家医院的重型颅脑损伤患者临床资料进行回顾性分析。观察患者术后6个月的结局，以GOS评分1~2分为不良预后，通过对建模数据集进行单因素和多因素Logistic回归分析，明确去骨瓣减压术后6个月不良预后的独立预测因素。利用R语言编程构建术后6个月内不良预后的早期预测模型，并对模型进行评价和验证。结果 最终有386例患者纳入研究，随机分为建模组286例，验证组100例。建模数据集6个月内总体不良预后率为55.59%。年龄、GCS、失血量＞750 ml、环池消失、术中低血压，以及APTT＞36 s是重型颅脑损伤患者行急诊去骨瓣减压术后6个月不良预后的独立影响因素（P＜0.05）。利用预测因素构建了预测模型，经评价和验证，提示模型均具备良好的区分能力，校准度。结论 基于颅脑损伤去骨瓣减压术后6个月总体不良预后的预测因素构建的预测模型，以预测列线图的方式展示，验证结果优良，可应用于临床。预测模型有助于指导医师临床决策，也可作为个体化治疗方案的参考。
Abstract:
Objective To construct a predictive model for the prognosis of emergency decompressive craniectomy in patients with severe craniocerebral injury and to evaluate and verify it.Methods The clinical data of patients with severe craniocerebral injury in 5 hospitals including Ganzhou People’s Hospital from January 2015 to January 2021 were retrospectively analyzed. The outcome of patients at 6 months after operation was observed, and the GOS score 1-2 was divided into poor prognosis. Univariate and multivariate Logistic regression analysis was performed on the modeling data set to identify the independent predictors of poor prognosis at 6 months after decompressive craniectomy. The early prediction model of poor prognosis within 6 months after operation was constructed by R language programming, and the model was evaluated and verified.Results A total of 386 patients were included in the study and randomly divided into the modeling group (286 patients) and the validation group (100 patients). The overall poor prognosis rate of the modeling data set within 6 months was 55.59%. Age, GCS, blood loss>750 ml, disappearance of ambient cistern, intraoperative hypotension, and APTT>36 s were independent influencing factors for poor prognosis at 6 months after emergency decompressive craniectomy in patients with severe craniocerebral injury (P<0.05). The prediction model was constructed by using the predictive factors. After evaluation and verification, it was suggested that the model had good discrimination ability and calibration.Conclusion The predictive model based on the predictivefactors of overall poor prognosis at 6 months after decompressive craniectomy for craniocerebral injury is displayed in the form of predictive nomogram, and the verification results are excellent and can be applied to clinical practice. The prediction model is helpful to guide the doctor’s clinical decision-making and can also be used as a reference for individualized treatment plan.

参考文献/References:

[1]向军武,常静静,刘宇,等.重型颅脑损伤去骨瓣减压术后并发脑积水的危险因素[J].中国临床神经外科杂志,2022,27(8):676-677.[2]魏乐,张伟,如克亚·白克力.重型颅脑损伤病人创伤后应激障碍的风险因素分析[J].中国临床神经外科杂志,2023,28(2):92-95.[3]Iaccarino C,Carretta A,Nicolosi F,et al.Epidemiology of severe traumatic brain injury[J].J Neurosurg Sci,2018,62(5):535-541.[4]伍荣乐.重症超声评估对重型颅脑损伤去骨瓣减压术后患者血管反应性、血流状态的影响[J].医学信息,2022,35(21):77-80.[5]Hawryluk GWJ,Rubiano AM,Totten AM,et al.Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations[J].Neurosurgery,2020,87(3):427-434.[6]霍利,丁立浩,嵇雪莱.去大骨瓣减压联合天幕裂孔切开对重型颅脑损伤合并脑疝患者神经功能及预后的影响[J].医学信息,2023,36(4):132-135.[7]de Cássia Almeida Vieira R,Silveira JCP,Paiva WS,et al.Prognostic Models in Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis[J].Neurocrit Care,2022,37(3):790-805.[8]Maeda Y,Ichikawa R,Misawa J,et al.External validation of the TRISS, CRASH, and IMPACT prognostic models in severe traumatic brain injury in Japan[J].PLoS One,2019,14(8):e0221791.[9]Barthélemy EJ,Melis M,Gordon E,et al.Decompressive Craniectomy for Severe Traumatic Brain Injury: A Systematic Review[J].World Neurosurg,2016,88:411-420.[10]Gao G,Wu X,Feng J,et al.China CENTER-TBI Registry Participants. Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study[J].Lancet Neurol,2020,19(8):670-677.[11]Bath S,Dinh MM,Casley S,et al.Predictors of mortality in older patients with isolated severe head injury: a data linkage study from New South Wales, Australia[J].Aust Health Rev,2022,46(1):107-114.[12]O’Donohoe RB,Lee HQ,Tan T,et al.The Impact of Preinjury Antiplatelet and Anticoagulant Use on Elderly Patients with Moderate or Severe Traumatic Brain Injury Following Traumatic Acute Subdural Hematoma[J].World Neurosurg,2022,166:e521-e527.[13]黄先锋,林小祥,李剑侠.重型颅脑损伤病人去骨瓣减压术后早期行颅骨修补的疗效及脑血流动力学变化[J].临床外科杂志,2021,29(10):919-924.[14]李强,杨朝华,刘仑鑫,等.重型颅脑创伤去骨瓣减压患者的临床特点和预后影响因素分析[J].中华神经外科杂志,2020,36(10):1012-1016.[15]丁唱,王晓宇,杨朝华,等.重型颅脑损伤去骨瓣减压手术前后颅内压对预后的影响[J].中华神经外科杂志,2022,38(5):456-459.[16]Powers AY,Pinto MB,Tang OY,et al.Predicting mortality in traumatic intracranial hemorrhage[J].J Neurosurg,2019,132(2):552-559.[17]Meyfroidt G,Bouzat P,Casaer M,et al.Management of moderate to severe traumatic brain injury: an update for the intensivist[J].Intensive Care Med,2022,48(6):649-666.[18]Baron T,Novak A.Tranexamic acid in acute traumatic brain injury[J].BMJ Evid Based Med,2021,26(6):e7.[19]Wada T,Shiraishi A,Gando S,et al.Pathophysiology of Coagulopathy Induced by Traumatic Brain Injury Is Identical to That of Disseminated Intravascular Coagulation With Hyperfibrinolysis[J].Front Med (Lausanne),2021,8:767637.[20]Saengrung S,Kaewborisutsakul A,Tunthanathip T,et al.Risk Factors for Intraoperative Hypotension During Decompressive Craniectomy in traumatic Brain Injury Patients[J].World Neurosurg,2022,162:e652-e658.

相似文献/References:

[1]周 强.颅脑创伤镇痛镇静的研究[J].医学信息,2019,32(14):46.[doi:10.3969/j.issn.1006-1959.2019.14.015]
　ZHOU Qiang.Study on Analgesia and Sedation of Traumatic Brain Injury[J].Journal of Medical Information,2019,32(18):46.[doi:10.3969/j.issn.1006-1959.2019.14.015]
[2]方 俊,姜永亮,黄 波.P38、MAPK-1和AQP-4在糖皮质激素调节大鼠创伤性脑水肿中的作用[J].医学信息,2019,32(21):56.[doi:10.3969/j.issn.1006-1959.2019.21.019]
　FANGJun,JIANG Yong-liang,HUANG Bo.The Role of P38,MAPK-1 and AQP-4 in Glucocorticoid Regulation of Traumatic Brain Edema in Rats[J].Journal of Medical Information,2019,32(18):56.[doi:10.3969/j.issn.1006-1959.2019.21.019]

更新日期/Last Update: 1900-01-01