个体化预测高血压脑出血病人术后再次出血的Nomogram模型的构建

The construction of a Nomogram model for individualized predicting postoperative rebleeding in patients with hypertensive cerebral hemorrhage

目的:探讨高血压脑出血(HICH)病人术后再次出血的危险因素并建立风险预警模型。方法:选取我院2019年8月-2020年10月收治的210例HICH病人作为研究对象,根据病人术后是否再次发生脑出血分为再次出血组(54例)和非再次出血组(156例),收集病人的临床资料进行单因素分析和Logistic回归分析,得出独立预测因素,构建列线图风险模型,并对该模型进行预测效能评价。结果:Logistic回归分析显示,病人术后24 h收缩压波动幅度≥50 mmHg、术后24 h舒张压波动幅度≥20 mmHg、术前凝血功能异常、发病至手术时间<6 h及术前血肿量≥60 mL是HICH病人术后再次出血的独立危险因素(P<0.05);基于危险因素建立列线图风险模型具有良好的区分度及一致性。结论:基于高血压脑出血病人术后再次出血的危险因素构建的风险预警模型可为病人术后再次出血评估提供针对性指导。

Objective:To explore the risk factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage(HICH)and to establish a risk warning model.Methods:A total of 210 HICH patients admitted to our hospital from August 2019 to October 2020 were selected as the research subjects.According to whether the patients had a recurrence of cerebral hemorrhage after surgery,they were divided into a recurrence group(54 cases)and a non-rebleeding group(156 cases).Patients′clinical data were collected for single-factor analysis and logistic regression analysis to obtain independent predictive factors,construct a nomogram risk model,and evaluate the predictive effectiveness of the model.Results:Logistic regression analysis showed that patients had systolic blood pressure fluctuations of≥50 mmHg 24 h after surgery,diastolic blood pressure fluctuations of≥20 mmHg 24 h after surgery,abnormal coagulation function before surgery,time from onset to surgery<6 h,and preoperative hematoma volume≥60 mL were the independent risk factors for postoperative rebleeding in HICH patients(P<0.05).The established nomogram risk model based on risk factors has good discrimination and consistency.Conclusions:The risk warning model constructed based on the risk factors of postoperative rebleeding in HICH patients can provide targeted guidance for evaluating patients with postoperative rebleeding.