中国实用神经疾病杂志2025，Vol.28Issue(3)：284-288,5.DOI:10.12083/SYSJ.240210
颅脑外伤患者去骨瓣减压术后短期内新发出血多指标联合预警模型的构建与验证
Construction and validation of a new multi-index warning model for new hemorrhage in the short term after decompressive craniectomy in patients with craniocerebral trauma
摘要
Abstract
Objective To construct and verify a new multi-index combined warning model for new hemorrhage in the short term after decompressive craniectomy in patients with craniocerebral trauma and its influence on the prognosis.Methods According to the new hemorrhage within 24 h after surgery,125 patients with craniocerebral trauma who underwent decompressive craniectomy in Baoding NO.1 Central Hospital from January 2022 to November 2023 were divided into the bleeding group and the non-bleeding group,and the clinical data of the two groups were compared.Logistic multivariate regression analysis was used to screen the risk factors for new hemorrhage in the short term after craniocerebral trauma,based on the above risk factors,a new blood flow prediction model for craniocerebral trauma patients after craniocerebral decompression was constructed,and the accuracy of this model was verified.The patients were followed up for 3 months after surgery and the prognosis was assessed according to Glasgow outcome scale(GOS).Results The rate of new hemorrhage after craniocerebral injury was 31.20％(39/125).Compared with the non-bleeding group,the bleeding combination with diabetes mellitus,preoperative Rotterdam CT score＞3,subdural hematoma,hematoma volume ≥ 30 mL,skull fracture,D-dimer(D-D)level were higher,thrombin time(TT)was longer,and fibrinogen(FIB)level was lower,the differences between both groups was statistically significant(P＜0.05).Logistic multivariate regression analysis showed that patients with diabetes mellitus(OR=1.822,95％CI:1.605-2.615)and preoperative Rotterdam CT score＞3(OR=1.816,95％CI:1.619-2.594),accompanied by subdural hematoma(OR=1.854,95％CI:1.637-2.738),hematoma volume≥30 mL(OR=1.865,95％CI:1.684-2.749),combined with skull fracture(OR=1.914,95％CI:1.658-2.815)and TT length(OR=1.825,95％CI:1.605-2.635)were independent risk factors for short-term new hemorrhage after craniocerebral injury craniectomy.Based on the preoperative Rotterdam CT score＞3,subdural hematoma,hematoma volume ≥ 30 mL,skull fracture and TT,the short-term new hemorrhage prediction model was constructed after craniocerebral injury craniectomy,the results showed that the C-index was 0.895(95％CI:0.757-0.942).The GOS grade in the non-bleeding group was better than that in the bleeding group 3 months after operation(P＜0.05),and the rate of grade V was about 58.14％(50/86).Conclusion Combined with diabetes mellitus,preoperative Rotterdam CT score＞3,subdural hematoma,hematoma volume≥30 mL,combined with skull fracture,and TT length are risk factors for short-term new hemorrhage after craniocerebral trauma decompressive craniectomy,the established multi-indicator combined warning model has high predictive efficacy and has a certain negative impact on prognosis,Clinical intervention can be carried out at an early stage in light of the actual situation.关键词
颅脑外伤/去骨瓣减压术/术后新发出血/预警模型/预后/危险因素Key words
Traumatic brain injury/Decompressive craniectomy/Postoperative new hemorrhage/Early warning model/Prognosis/Risk factors分类
临床医学引用本文复制引用
贾振岭,徐冬静,李佳,单玉超,李静..颅脑外伤患者去骨瓣减压术后短期内新发出血多指标联合预警模型的构建与验证[J].中国实用神经疾病杂志,2025,28(3):284-288,5.基金项目
河北省2020年度医学科学研究课题计划项目(编号:20200172) （编号:20200172）
保定市科技计划项目(编号:2341ZF156) （编号:2341ZF156）
