Risk factors and prediction model construction of poor prognosis in patients with traumatic craniocerebral injury treated with hyperbaric oxygen therapy
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摘要 目的:探讨高压氧治疗创伤性颅脑损伤患者预后不良的危险因素,并构建预测模型,以期为进一步改善患者预后提供参考。方法:采用队列研究方法,选择2021年1月至2023年1月在空军军医大学第二附属医院接受高压氧治疗的182例创伤性颅脑损伤患者,根据治疗1个月后的格拉斯哥预后评分(GOS)分为预后不良组(n=119)与预后良好组(n=63)。对比两组临床资料。构建logistic回归预测模型,分析高压氧治疗创伤性颅脑损伤预后的影响因素;受试者工作特征曲线(ROC)分析各因素预测高压氧治疗创伤性颅脑损伤预后的价值。结果:预后不良组蛛网膜下腔出血、环池消失发生率高于预后良好组,血小板计数、血浆纤维蛋白原水平低于预后良好组(均P<0.05)。多因素logistic回归模型显示,蛛网膜下腔出血、环池消失为高压氧治疗创伤性颅脑损伤患者预后的危险因素,血小板计数增加、血浆纤维蛋白原水平升高为保护因素(均P<0.05)。蛛网膜下腔出血、环池消失、血小板计数、血浆纤维蛋白原预测高压氧治疗创伤性颅脑损伤患者预后的ROC曲线下面积(AUC)分别为0.649、0.610、0.794、0.779(均P<0.05),且模型可靠、稳定(AUC=0.894,P<0.05)。结论:蛛网膜下腔出血、环池消失、血小板计数减少、血浆纤维蛋白原水平降低为高压氧治疗创伤性颅脑损伤患者预后不良的影响因素,基于上述危险因素构建的预测模型对患者预后不良的预测价值较高。Abstract Objective: To explore the risk factors of poor prognosis in patients with traumatic craniocerebral injury treated with hyperbaric oxygen therapy and construct a prediction model, so as to provide a reference for further improving the prognosis of patients. Methods: A total of 182 patients with traumatic craniocerebral injury who received hyperbaric oxygen therapy in the Second Affiliated Hospital of Air Force Medical University from January 2021 to January 2023 were selected using the method of queue research. According to the Glasgow outcome scale(GOS) one month after treatment, they were divided into the poor prognosis group(n=119) and the good prognosis group(n=63). The clinical data of the two groups were compared. The logistic regression prediction model was constructed and the factors influencing the prognosis of hyperbaric oxygen therapy for traumatic craniocerebral injury were analyzed. The receiver operating characteristic(ROC) curve was used to analyze the value of multi-factor prediction of prognosis of hyperbaric oxygen therapy for traumatic craniocerebral injury. Results: The incidence of subarachnoid hemorrhage and disappearance of annular cisterna in the poor prognosis group was higher than that in the good prognosis group, and the platelet count and plasma fibrinogen level were lower than those in the good prognosis group(all P<0.05). The multivariate logistic regression model showed that subarachnoid hemorrhage and disappearance of annular cisterna were risk factors for the prognosis of patients with traumatic craniocerebral injury treated with hyperbaric oxygen therapy, and the increase of platelet count and plasma fibrinogen level were protective factors(all P<0.05). The areas under the ROC curve(AUC)of subarachnoid hemorrhage, disappearance of annular cisterna, platelet count and plasma fibrinogen for predicting the prognosis in patients with traumatic craniocerebral injury treated with hyperbaric oxygen therapy were0.649, 0.610, 0.794 and 0.779, respectively(all P<0.05), and the model was reliable and stable(AUC=0.894,P<0.05). Conclusion: Subarachnoid hemorrhage, disappearance of annular cisterna, decreased platelet count and decreased plasma fibrinogen level are the influencing factors of poor prognosis in patients with traumatic brain injury treated with hyperbaric oxygen therapy. The prediction model based on the above risk factors has a high predictive value for poor prognosis of patients.
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