国际神经病学神经外科学杂志2025，Vol.52Issue(2)：23-29,7.DOI:10.16636/j.cnki.jinn.1673-2642.2025.02.003
高血压脑出血合并急性意识障碍患者遗留慢性意识障碍的影响因素分析及列线图模型构建
Analysis of influencing factors and nomogram model construction for prolonged disorders of consciousness in patients with hypertensive intracerebral hemorrhage complicated by acute disorders of consciousness
摘要
Abstract
Objective To investigate the influencing factors associated with progression to prolonged disorders of consciousness in patients with hypertensive intracerebral hemorrhage complicated by acute consciousness impairment and to develop a predictive model.Methods This study was based on a retrospective analysis of 172 patients admitted to the Department of Neurosurgery at The First Affiliated Hospital of Nanjing Medical University from June 2021 to June 2023.All patients presented with acute disorders of consciousness,defined by Glasgow coma scale(GCS)of 3-12 upon admission.The study population was divided into prolonged disorders of consciousness(n=46)and non-prolonged disorders of consciousness(n=126)groups based on Coma Recovery Scale-Revised(CRS-R)assessments conducted during a minimum three-month follow-up period.Results Statistical analysis revealed significant differences between the groups across multiple variables,including age,diabetes history,admission GCS,hemorrhage location,hematoma volume,preoperative midline shift,GCS scores at seven days post-onset,and the occurrence of secondary cerebral infarction(P<0.05).Binary logistic regression analysis identified several independent factors affecting consciousness outcomes.A higher GCS at seven days post-onset emerged as a protective factor(OR=1.387,95%CI=1.129～1.702),while a history of diabetes(OR=0.274,95%CI=0.093～0.806),thalamic hemorrhage(OR=0.033,95%CI=0.003～0.366),and secondary cerebral infarction(OR=0.283,95%CI=0.106～0.755,)were identified as independent risk factors for prolonged disorders of consciousness.Based on these findings,a nomogram prediction model was developed,demonstrating excellent predictive capability with a concordance index of 0.822 and robust calibration(average absolute error=0.037).Conclusions Study findings indicate that the GCS at 7 days post-onset,history of diabetes mellitus,thalamic hemorrhage,and secondary cerebral infarction constitute critical determinants influencing progression to prolonged disorders of consciousness in patients with intracerebral hemorrhage complicated by acute consciousness impairment.The predictive model incorporating these factors demonstrated high accuracy.关键词
高血压脑出血/急性意识障碍/慢性意识障碍/列线图模型/影响因素/预测模型/格拉斯哥昏迷评分Key words
hypertensive intracerebral hemorrhage/acute disorders of consciousness/prolonged disorders of consciousness/nomogram model/influencing factors/predictive model/Glasgow coma scale分类
临床医学引用本文复制引用
沈之焱,王希,颜伟,尤永平..高血压脑出血合并急性意识障碍患者遗留慢性意识障碍的影响因素分析及列线图模型构建[J].国际神经病学神经外科学杂志,2025,52(2):23-29,7.基金项目
江苏省科教能力提升工程(ZDXK202225) （ZDXK202225）
江苏省人民医院临床能力提升项目(JSPH-MC-2023-14). （JSPH-MC-2023-14）
