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颅脑术后病人下肢静脉血栓发生的列线图预测模型

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目的 探索颅脑术后病人下肢静脉血栓发生的危险因素,建立下肢静脉血栓发生的列线图预测模型.方法 选取2018年1月~2020年12月我院因颅脑外伤行开颅手术病人共427例为训练集,绘制列线图并进行内部验证,2021年1月~2021年6月手术病人共106例为验证集,对模型进行外部验证.对于训练集进行单因素分析后纳入所有P<0.05的变量进行多因素Logis-tic 回归分析,使用R软件绘制列线图.在训练集与验证集中分别通过C指数、校准图和决策曲线分析来验证列线图性能.结果 训练集427例,发生下肢静脉血栓107例,发生率25.1%.验证集106例,发生下肢静脉血栓33例,发生率31.1%.多因素Logistic回归分析显示,病人年龄、术前格拉斯哥昏迷评降低、术后下肢肌力<3级、高血压、糖尿病为颅脑术后下肢静脉血栓发生的高危因素.训练集和验证集列线图的C指数分别为0.837(95%CI:0.796~0.878)和0.933(95%CI:0.886~0.979).结论 由病人年龄、术前GCS评分、术后下肢肌力<3级、高血压、糖尿病构建的列线图能便捷、准确、可靠地预测颅脑术后下肢静脉血栓发生的概率.
Prognostic nomogram for predicting lower limb venous thrombosis in patients after craniocerebral surgery
Objective To explore the risk factors for lower limb venous thrombosis in patients after craniocerebral surgery,and establish a prognostic nomogram for the occurrence of lower limb venous thrombosis.Methods A total of 427 patients who underwent craniotomy for craniocerebral trauma and met the inclusion criteria in the First People's Hospital of Taicang from January 2018 to December 2020 were collected as training group,and the nomogram was drawn and verified internally.And 106 patients who underwent surgery from January 2021 to June 2021 were used as test group,and the model was externally verified set.The nomogram was established and internally validated with the data of the training group,and externally validated with the data of the test group.For the training group,multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis,and established the prognostic nomogram by R software.In the training group and the test group,the performance of the nomogram was verified by C-index,calibration chart and decision curve analysis respectively.Results In the training group of 427 people,107 had lower limb venous thrombosis,with an incidence rate of 25.1%.Among the 106 people in the test group,33 developed lower limb venous thrombosis,with an incidence rate of 31.1%.Multivariate logistic regression analysis showed that age,lower preoperative GCS score,postoperative lower limb muscle strength<3,hypertension,and diabetes were independent risk factors for the occurrence of lower limb vein thrombosis after craniocerebral surgery.The C-index of this nomogram in the training group and the test group was 0.837(95%CI:0.796-0.878)and 0.933(95%CI:0.886-0.979),respectively.Conclusion The nomogram including the age,preoperative GCS score,postoperative lower limb muscle strength<3,hypertension,and diabetes can predict the probability of lower limb vein thrombosis after craniocerebral surgery with convenient discrimination and clinical utility.

post craniocerebral surgerylower limb venous thrombosisnomogrampredictive model

葛志强、左刚、徐前、梁继尧、陈毅斌、霍俊杰、姜明

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215400 江苏省太仓市第一人民医院神经外科

颅脑术后 下肢静脉血栓 列线图 预测模型

太仓市科学技术局

TC2020JCYL23

2024

临床外科杂志
中华医学会湖北分会

临床外科杂志

CSTPCD
影响因子:0.716
ISSN:1005-6483
年,卷(期):2024.32(7)