重型颅脑损伤患者术后继发性脑积水的危险因素分析及列线图风险模型构建

赖燕玲; 蔡冬梅; 卓晶晶; 李浩; 李文辉

doi:10.7619/jcmp.20242442

重型颅脑损伤患者术后继发性脑积水的危险因素分析及列线图风险模型构建

1.
中国人民解放军联勤保障部队第九一〇医院神经外科, 福建泉州, 362000
2.
厦门大学附属翔安医院器官移植科, 福建厦门, 361102
3.
厦门大学附属翔安医院健康管理中心, 福建厦门, 361102

基金项目:

福建省科技厅自然科学基金项目(杰青项目) 2023J01310519

详细信息

通讯作者:
李文辉

中图分类号: R743;R651.1;R445
计量
- 文章访问数: 45
- HTML全文浏览量: 13
- PDF下载量: 15
出版历程
- 收稿日期: 2024-06-09
- 修回日期: 2024-09-05
- 刊出日期: 2025-01-14

Risk factors for postoperative secondary hydrocephalus in patients with severe craniocerebral injury and construction of nomogram risk model

1.
Department of Neurosurgery, the 910th Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Quanzhou, Fujian, 362000
2.
Department of Organ Transplantation, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, 361102
3.
Health Management Center, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, 361102

摘要

摘要:
目的
探讨重型颅脑损伤患者术后继发性脑积水的危险因素, 并构建列线图预测模型。
方法
选取360例重型颅脑损伤患者作为研究对象，并根据术后继发性脑积水发生情况分为脑积水组(n=34)和非脑积水组(n=326)。采用Logistic回归分析法筛选术后继发性脑积水的危险因素。基于筛选出的危险因素构建重型颅脑损伤患者术后继发性脑积水的列线图模型，并验证其预测效能。
结果
360例患者中，术后发生继发性脑积水34例，继发性脑积水发生率为9.44%(34/360)。Logistic回归分析结果显示，颅内感染、脑室出血、中线移位程度≥12 mm、术前格拉斯哥昏迷评分法(GCS)评分3~5分、去骨瓣减压、硬膜敞开是重型颅脑损伤患者术后继发性脑积水的独立危险因素(P < 0.05)。基于上述危险因素构建的列线图模型的模型一致性指数为0.874, 曲线下面积为0.831。
结论
本研究基于颅内感染、脑室出血、中线移位程度、术前GCS评分、去骨瓣减压及硬膜敞开因素构建的列线图模型，能够有效预测重型颅脑损伤患者术后继发性脑积水的风险，对早期防治具有临床指导意义。
- 重型颅脑损伤 /
- 脑积水 /
- 危险因素 /
- 列线图 /
- 颅内感染
Abstract:
Objective
To explore the risk factors for postoperative secondary hydrocephalus in patients with severe craniocerebral injury and construct a nomogram prediction model.
Methods
A total of 360 patients with severe craniocerebral injury were selected as the study subjects, and divided into hydrocephalus group (n=34) and non-hydrocephalus group (n=326) based on the occurrence of postoperative secondary hydrocephalus. Logistic regression analysis was used to screen for risk factors of postoperative secondary hydrocephalus. A nomogram model for predicting postoperative secondary hydrocephalus in patients with severe craniocerebral injury was constructed based on the identified risk factors, and its predictive performance was validated.
Results
Among the 360 patients, 34 developed secondary hydrocephalus after surgery, with an incidence rate of 9.44% (34/360). Logistic regression analysis revealed that intracranial infection, ventricular hemorrhage, midline shift ≥12 mm, preoperative Glasgow Coma Scale (GCS) score of 3 to 5, decompressive craniectomy and dura mater opening were independent risk factors for postoperative secondary hydrocephalus in patients with severe traumatic brain injury (P < 0.05). The concordance index of the nomogram model constructed based on these risk factors was 0.874, and the area under the curve was 0.831.
Conclusion
The nomogram model constructed in this study based on factors such as intracranial infection, ventricular hemorrhage, midline shift, preoperative GCS score, decompressive craniectomy and dura mater opening, effectively predicts risk of postoperative secondary hydrocephalus in patients with severe traumatic brain injury. This model has clinical significance for early prevention and treatment.
- severe craniocerebral injury /
- hydrocephalus /
- risk factors /
- nomogram /
- intracranial infection

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图 1 重型颅脑损伤患者术后继发性脑积水风险的列线图预测模型

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图 2 列线图模型的校正曲线验证

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图 3 列线图模型的ROC曲线验证

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表 1 脑积水组和非脑积水组临床资料比较(x±s)[n(%)]

临床资料	分类	脑积水组(n=34)	非脑积水组(n=326)	t/χ²	P
性别	男	20(58.82)	196(60.12)	0.022	0.883
	女	14(41.18)	130(39.88)
年龄/岁		53.24±8.26	54.77±9.13	0.938	0.349
体质量指数/(kg/m²)		22.71±2.02	22.35±2.43	0.834	0.405
居住地	乡村	18(52.94)	169(51.84)	0.015	0.903
	城镇	16(47.06)	157(48.16)
吸烟	是	11(32.35)	126(38.65)	0.518	0.472
	否	23(67.65)	200(61.35)
饮酒	是	14(41.18)	132(40.49)	0.006	0.938
	否	20(58.82)	194(59.41)
致伤原因	交通伤	18(52.94)	152(46.63)	0.493	0.483
	坠落伤	16(47.06)	174(53.37)
骨瓣位置	单侧	6(17.65)	62(19.02)	0.038	0.846
	双侧	28(82.35)	264(80.98)
开放性颅脑损伤	是	20(58.82)	134(41.10)	3.949	0.047
	否	14(41.18)	192(58.90)
颅内感染	是	16(47.06)	76(23.31)	9.125	0.003
	否	18(52.94)	250(76.69)
脑室出血	是	22(64.71)	124(38.04)	9.083	0.003
	否	12(35.29)	202(61.96)
中线移位程度	≥12 mm	24(70.59)	140(42.94)	9.486	0.002
	< 12 mm	10(29.41)	186(57.06)
术前GCS评分	3~5分	13(38.24)	52(15.95)	10.334	0.001
	6~8分	21(61.76)	274(84.05)
平均手术时间	≥3 h	19(55.88)	177(54.29)	0.031	0.860
	< 3 h	15(44.12)	149(45.71)
去骨瓣减压	是	21(61.76)	111(34.05)	10.186	0.001
	否	13(38.24)	215(65.95)
腰穿脑脊液置换	是	10(27.41)	52(15.95)	3.913	0.048
	否	24(70.59)	274(84.05)
硬膜敞开	是	25(73.53)	148(45.40)	9.760	0.002
	否	9(26.47)	178(54.60)
GCS: 格拉斯哥昏迷评分法。

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表 2 变量赋值方式

变量	赋值方式
术后是否继发性脑积水	未发生=0, 发生=1
开放性颅脑损伤	否=0, 是=1
颅内感染	否=0, 是=1
脑室出血	否=0, 是=1
中线移位程度	< 12 mm=0, ≥12 mm=1
术前GCS评分	6~8分=0, 3~5分=1
去骨瓣减压	否=0, 是=1
腰穿脑脊液置换	否=0, 是=1
硬膜敞开	否=0, 是=1

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表 3 重型颅脑损伤患者术后继发性脑积水的危险因素分析

因素	回归系数	标准误	Wald	P	OR	95%置信区间
因素	回归系数	标准误	Wald	P	OR	下限	上限
颅内感染	1.021	0.408	6.254	0.012	2.777	1.247	6.183
脑室出血	1.156	0.412	7.871	0.005	3.176	1.417	7.119
中线移位程度≥12 mm	1.157	0.426	7.385	0.007	3.180	1.381	7.324
术前GCS评分3~5分	1.254	0.436	8.274	0.004	3.505	1.491	8.239
去骨瓣减压	1.151	0.411	7.842	0.005	3.162	1.413	7.076
硬膜敞开	1.318	0.439	9.033	0.003	3.736	1.582	8.823
常数	-5.552	0.681	66.513	< 0.001	0.004	—	—

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