Objective To construct a risk line chart model for postoperative rebleeding after endoscopic removal of intracerebral hematoma and validate it.Method The clinical data of 162 patients with primary cerebral hemorrhage admitted to Fenjinting Hospital of Suqian from January 2019 to July 2023 were analyzed retrospectively.All patients underwent endoscopic removal of intracerebral hematoma and were divided into postoperative rebleeding group(n=32)and postoperative non rebleeding group(n=130)based on whether postoperative rebleeding occurred.Results The age of the postoperative re bleeding group was higher than that of the postoperative non rebleeding group,the number of hypertensive cases was lower than that of the postoperative non rebleeding group,and the time from onset to surgery was longer than that of the postoperative non rebleeding group.The Glasgow coma scale(GCS)at admission,the amount of hematoma at admission,the number of positive island sign cases,and postoperative intracranial pressure were all higher than those of the postoperative non rebleeding group.The hematoma clearance rate and the number of bleeding vessels around the hematoma were significantly lower than those of the postoperative non rebleeding group(P＜0.05).The results of logistic regression analysis showed that a history of hypertension,time from onset to surgery,GCS score at admission,hematoma volume at admission,positive island sign,careful handling of bleeding vessels around the hematoma,postoperative intracranial pressure,and hematoma clearance rate were the influencing factors of postoperative rebleeding after neuroendoscopic removal of intracerebral hematoma(P＜0.05).The column chart model showed that for every 3 hours increased in the time from onset to surgery,the corresponding score increased by 10 points.For every 5 points increased in GCS score upon admission,the corresponding score increased by 10 points.For every 10 mL increased in hematoma volume upon admission,the corresponding score increased by 5 points.For every 10％decreased in hematoma clearance rate,the corresponding score increased by 8 points.For every 4 mmHg increased in postoperative intracranial pressure,the corresponding score increased by 8 points.Careful handling of bleeding vessels around the hematoma results in a corresponding score of 0(no),and 10 points(yes).Island sign negative(0)corresponded to a score of 0,positive(1)corresponded to a score of 8.The receiver operating characteristic(ROC)curve analysis results showed that the area under curve(AUC)of the column chart model predicting postoperative rebleeding after endoscopic removal of intracerebral hematoma was 0.992(95％confidence interval:0.983-1.00).The results of the Hosmer Lemeshow goodness of fit test showed that there was no statistically significant difference between the prediction of postoperative rebleeding under neuroendoscopic clearance of intracerebral hematoma using the column chart model and the actual incidence rate(x2=8.147,P=0.879).Conclusions A history of hypertension,time from onset to surgery,GCS score upon admission,hematoma volume upon admission,positive island sign,careful management of bleeding vessels around the hematoma,and postoperative intracranial pressure are risk factors for postoperative rebleeding after neuroendoscopic removal of intracerebral hematoma.A risk prediction column chart model constructed based on these risk factors has certain predictive value for postoperative rebleeding after neuroendoscopic removal of intracerebral hematoma,this can provide a basis for the development of effective preventive measures in clinical practice.
维普
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