急性缺血性脑卒中患者颅内压增高风险预测模型的构建

Construction of risk prediction model for intracranial pressure increase in patients with acute ischemie stroke

目的构建急性缺血性脑卒中(AIS)患者颅内压(ICP)增高风险预测模型,并验证其效度。方法191例AIS患者分为两组;其中,ICP增高组140例,ICP未增高组51例。比较两组基本资料,采用单因素和多因素logistic回归分析AIS患者ICP增高的影响因素。根据多因素logistic回归分析结果,构建AIS患者ICP增高发生的预测模型,将外部验证组66例AIS患者带入模型中,评估预测模型的效度。结果单因素logistic回归分析结果显示,GCS评分、体温、呼吸频率、收缩压、舒张压、PaCO_(2)及出现大面积脑梗死、呕吐、脑水肿和脑电频率变慢与ICP增高有关(P<0.05)。多因素logistic回归分析显示,舒张压升高、PaCO_(2)降低、出现大面积脑梗死和脑水肿是AIS患者ICP增高的独立危险因素(P<0.05)。根据多因素logistic回归分析结果,构建仅包含舒张压、PaCO_(2)、大面积脑梗死和脑水肿的ICP增高发生预测模型,ROC曲线分析结果显示,预测模型预测AIS患者发生ICP增高的AUC为0.968[95%CI(0.932~0.988)]。将外部验证组66例AIS患者带入预测模型中,ROC曲线分析结果显示验证模型预测患者发生ICP增高的AUC为0.992[95%CI(0.931~1.000)]。结论AIS患者出现舒张压升高、PaCO_(2)降低、大面积脑梗死和脑水肿时发生ICP增高的风险较大。AIS患者ICP增高风险预测模型的拟合效果较好,可为AIS患者的临床护理观察及ICP增高的评价提供有价值的依据。

Objective To establish a prediction model for risk assessment of increased intracranial pressure(ICP)in the patients with acute ischemic stroke(AIS)and verify its validity.MethodsA total of 191 AIS patients were selected,of whom 140 cases were with increased ICP(group A)and 51 cases were without an increase of ICP(group B).The basic data of the two groups were compared,and the influencing factors for increased ICP in AIS patients were analyzed by univariate and multivariate logistic regression.According to the results of multivariate logistic regression analysis,a prediction model for the occurrence of increased ICP in AIS patients was constructed,and 66 AIS patients from the external validation group were brought into the model to evaluate the validity of the prediction model.Results Univariate logistic regression analysis showed that GCS score,body temperature,respiratory rate,systolic blood pressure,diastolic blood pressure,PaCO_(2),as well as the occurrence of massive cerebral infarction,vomiting,cerebral edema and slow cerebral electrical frequency were associated with increased ICP(P<0.05).Multivariate logistic regression analysis showed that increased diastolic blood pressure,decreased PaCO_(2),massive cerebral infarction and cerebral edema were the independent risk factors for increased ICP in AIS patients(P<0.05).According to the results of multivariate logistic regression analysis,a prediction model of increased ICP occurrence was constructed,which only included diastolic blood pressure,PaCO_(2),massive cerebral infarction and brain edema.ROC curve analysis showed that the AUC of increased ICP in AIS patients predicted by the prediction model was 0.968[95%CI(0.932-0.988)].Sixty-six AIS patients in the external validation group were brought into the prediction model,and ROC curve analysis showed that the AUC of the patients with increased ICP predicted by the external validation model was 0.992[95%CI(0.931-1.000)].Conclusion AIS patients have higher risk of increased diastolic blood pressure,decreased PaCO_(2),massive cerebral infarction and cerebral edema.The fitting effect of the prediction model for risk assessment of increased ICP in AIS patients is better,which can provide valuable basis for clinical nursing and evaluation of increased ICP in AIS patients.