实用临床医药杂志2025，Vol.29Issue(3)：57-63,69,8.DOI:10.7619/jcmp.20242759
重型创伤性脑损伤患者并发急性呼吸窘迫综合征的影响因素及预测模型构建
Influencing factors of severe traumatic brain injury patients with acute respiratory distress syndrome and construction of predictive model
摘要
Abstract
Objective To explore the risk factors associated with the development of acute respir-atory distress syndrome(ARDS)in patients with severe traumatic brain injury(sTBI)and to construct and validate a risk prediction model for ARDS in these patients.Methods Clinical data from 371 sTBI patients admitted to Yangzhou Affiliated Hospital of Yangzhou University between January 2017 and December 2023 were retrospectively collected.Patients were randomly divided into modeling group(n=259)and validation group(n=112)at a 7-to-3 ratio.A nomogram model was constructed after screening for risk factors using the Least Absolute Shrinkage and Selection Operator(LASSO)and multivariate Logistic regression analysis.Model performance was evaluated using the receiver operating characteristic(ROC)curve,area under the curve(AUC),Hosmer-Lemeshow test,calibration curve,and deci-sion curve analysis(DCA).Results Statistically significant differences were observed in heart rate,respiratory rate,pupil size,percutaneous oxygen saturation(SpO2),Glasgow Coma Scale(GCS)score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,head Ab-breviated Injury Scale(AIS)score,chest AIS score,emergency intubation,pulmonary infection,associated chest trauma,midline shift,blood transfusion within 12 hours of admission,fluid intake within 24 hours of admission,shock,mechanical ventilation,hemoglobin level,hematocrit,white blood cell count,prothrombin time,international normalized ratio,total protein,albumin,serum calcium,oxygenation index,and base excess between the two groups(P＜0.05).Multivariate Lo-gistic regression analysis revealed that SpO2,pulmonary infection,and fluid intake within 24 hours of admission were predictors of ARDS in sTBI patients.The Hosmer-Lemeshow test results for the modeling and validation groups showed good fit(x2=10.373,P=0.240;x2=13.21,P=0.105).DCA results for both groups indicated net benefit at threshold probabilities ranging from 0％to 72％and 0％to 50％,respectively.Conclusion SpO2,pulmonary infection,and fluid in-take within 24 hours of admission are risk factors for ARDS in sTBI patients.The model constructed using these factors demonstrates good performance and provides a reliable tool for clinical screening of high-risk ARDS populations among sTBI patients.关键词
重型创伤性脑损伤/急性呼吸窘迫综合征/影响因素/预测模型Key words
severe traumatic brain injury/acute respiratory distress syndrome/influencing factors/prediction model分类
临床医学引用本文复制引用
王梓璇,庄金强,肖燕,朱敏,王愚,许思瑶,钟园,刘晓红..重型创伤性脑损伤患者并发急性呼吸窘迫综合征的影响因素及预测模型构建[J].实用临床医药杂志,2025,29(3):57-63,69,8.基金项目
扬州市-扬州大学市校合作共建创新平台扬州市大数据分析与知识服务重点实验室开放课题资助项目(YBK202208) （YBK202208）
