联合预测因子对重型颅脑损伤患者行去骨瓣减压术后早期不良结局的预测研究

Study on the prediction of early adverse outcomes after decompressive craniectomy in patients with severe traumatic brain injury by combined predictors

目的探讨重型颅脑损伤患者(s TBI)行去骨瓣减压术(DC)后早期不良结局发生的影响因素,并构建联合预测因子对早期不良结局进行预测。方法回顾性分析2019年7月至2022年12月于我院接受DC治疗的114例s TBI患者的临床资料。采用单因素分析影响s TBI患者DC后早期不良结局的可能因素,后用二元Logistic回归分析探讨独立影响因素,通过独立影响因素的B值构建联合预测因子,并绘制受试者工作特征(ROC)曲线对早期不良结局进行预测。结果出院时格拉斯哥预后量表(GOS)评分为4分的70例患者纳入早期良好结局组,GOS评分为2~3分的44例患者纳入早期不良结局组。两组的年龄、瞳孔变化、入院时格拉斯哥昏迷量表(GCS)评分、受伤至手术时间及手术方式比较,差异具有统计学意义(P<0.05)。年龄大、受伤至手术时间长为DC后患者早期不良结局的危险因素,入院时GCS评分高为DC后患者早期不良结局的保护因素(P<0.05)。构建联合预测因子ROC曲线分析显示,曲线下面积(AUC)为0.944,灵敏度为95.45%,特异度为88.57%。结论患者的年龄、入院时GCS评分及受伤至手术时间可作为联合预测因子对s TBI患者行DC后早期不良结局进行预测,可为临床治疗提供帮助。

Objective To explore the influencing factors of early adverse outcomes in patients with severe traumatic brain injury(sTBI)after decompressive craniectomy(DC),and to construct combined predictors to predict early adverse outcomes.Methods The clinical data of 114 patients with sTBI who received DC treatment in our hospital from July 2019 to December 2022 were retrospectively analyzed.Univariate analysis was used to analyze the possible factors affecting the early adverse outcomes after DC in sTBI patients.After that,binary Logistic regression analysis was used to explore the independent influencing factors.The B value of independent influencing factors was used to construct combined predictors,and the receiver operating characteristic(ROC)curve was drawn to predict the early adverse outcomes.Results A total of 70 patients with Glasgow Outcome Scale(GOS)score of 4 points at discharge were included in the early good outcome group,a total of 44 patients with GOS score of 2-3 points were included in the early adverse outcome group.There were significant differences in age,pupil changes,Glasgow Coma Scale(GCS)score at admission,time from injury to operation and surgical methods between the two groups(P<0.05).Old age and long time from injury to operation were risk factors for early adverse outcomes in patients after DC,and high GCS score at admission was a protective factor for early adverse outcomes in patients after DC(P<0.05).The ROC curve analysis of the combined predictors showed that the areas under curve(AUC)was 0.944,the sensitivity was 95.45%,and the specificity was 88.57%.Conclusion The patients'age,GCS score at admission and time from injury to operation can be used as a combined predictor to predict the early adverse outcomes of sTBI patients after DC,which can provide help for clinical treatment.