高血压脑出血患者微创穿刺血肿引流术后再出血危险因素分析及预测模型建立

Analysis of risk factors for rebleeding after minimally invasive hematoma drainage in patients with hypertensive intracerebral hemorrhage and establishment of predictive model

目的构建预测高血压脑出血患者微创穿刺血肿引流术后再出血的列线图模型,并进行评估及验证。方法回顾性分析2017年3月至2021年1月在本院接受微创穿刺血肿引流术治疗的450例高血压脑出血患者的临床资料,根据术后有无再出血,分为再出血组(50例)和未再出血组(400例)。收集患者临床资料,多因素Logistic回归分析影响高血压脑出血患者术后再出血的危险因素。采用R软件构建预测高血压脑出血患者术后再出血的列线图模型,并使用ROC曲线及校准曲线验证列线图模型的区分度和一致性。决策曲线分析(DCA)评价模型的临床适用性。结果再出血组收缩压>200 mmHg比例(1 mmHg=0.133 kPa)、舒张压>120 mmHg比例、入院时脑出血血肿量≥60 ml比例、入院前GCS评分3~8分比例、发病至入院时间、首次血肿清除率均明显高于无再出血组(均P<0.05)。多因素Logistic回归分析结果显示,收缩压>200 mmHg、舒张压>120 mmHg、脑出血血肿量≥60 ml、发病至入院时间是影响高血压脑出血患者微创穿刺血肿引流术后再出血发生的危险因素(均P<0.05)。构建的列线图预测模型具有较好的区分度(ROC曲线下面积为0.866)与一致性(Hosmer-Lemeshow拟合优度检验:6.443,P=0.598)。DCA表明模型在一定范围内具有临床适用性。结论本研究构建的预测高血压脑出血患者微创穿刺血肿引流术后再出血风险的列线图模型,具有较好的区分度、一致性及临床适用性。

Objective To construct a nomogram model for predicting rebleeding after minimally invasive hematoma drainage in patients with hypertensive intracerebral hemorrhage,and to evaluate and verify it.Methods The clinical data of 450 patients with hypertensive intracerebral hemorrhage who underwent minimally invasive hematoma drainage treatment in our hospital from March 2017 to January 2021 were retrospectively analyzed.According to whether the included patients had rebleeding after surgery,they were divided into rebleeding group(50 cases)and non⁃rebleeding group(400 cases).The clinical data of patients were collected,and multivariate Logistic regression analysis was used to analyze the risk factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage.R software was used to construct a nomogram model for predicting postoperative rebleeding in patients with hypertensive intracerebral hemorrhage,and the ROC curve and calibration curve were used to verify the distinction and consistency of the nomogram model.Decision curve analysis(DCA)was used to evaluate the clinical applicability of the model.Results In the rebleeding group,the ratio of systolic blood pressure>200 mmHg(1 mmHg=0.133 kPa),the ratio of diastolic blood pressure>120 mmHg,the ratio of cerebral hemorrhage hematoma volume≥60 ml at admission,the ratio of GCS score of 3-8 points before admission,the time from onset to hospital admission and the first clearance rate of hematoma were significantly higher than those in non⁃rebleeding group(all P<0.05).Multivariate Logistic regression analysis showed that systolic blood pressure>200 mmHg,diastolic blood pressure>120 mmHg,cerebral hemorrhage hematoma volume≥60 ml and the time from onset to hospital admission were risk factors affecting rebleeding after minimally invasive puncture hematoma drainage in patients with hypertensive intracerebral hemorrhage(all P<0.05).The constructed nomogram prediction model had a good degree of discrimination(the area under the ROC curve was 0.866)and consistent(Hosmer⁃Lemeshow good⁃ness of fit test:6.443,P=0.598).DCA showed that the model had clinical applicability within a certain range.Conclusion The nomogram model constructed in this study has good discrimination,consistency and clinical applicability to predict the risk of rebleeding after minimally invasive puncture hematoma drainage in patients with hypertensive intracerebral hemorrhage.