| 李 博,冯丽霞.脑外伤患者经鼻高流量氧疗干预无效预测模型的建立与验证[J].中国烧伤创疡杂志,2025,(1):37~42. |
| DOI： |
| 中文关键词: 脑外伤 经鼻高流量氧疗 无效 预测模型 有效性 预测价值 |
| 英文关键词:Traumatic brain injury Nasal high-flow oxygen therapy Ineffectiveness Prediction model Validation Predictive value |
| 基金项目:南阳市科技发展计划项目 (KJGG097) |
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| 中文摘要: |
| 【摘要】 目的 建立脑外伤患者经鼻高流量氧疗干预无效的风险预测模型, 并验证其预测价值。 方法 选取2019年2月至 2023年3月南阳市第一人民医院收治的480例行经鼻高流量氧疗干预的脑外伤患者作为研究对象, 收集患者经鼻高流量氧疗前动脉血氧分压/ 动脉血二氧化碳分压 (PaO2/ PaCO2 )、氧合指数 (PaO2/ FiO2 )?格拉斯哥昏迷量表( GCS)评分、序贯器官衰竭( SOFA) 评分、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、pH值以及乳酸、脑钠肽 (BNP)、C反应蛋白 (CRP)、降钙素原 (PCT) 水平等相关资料与经鼻高流量氧疗干预情况, 并根据干预后是否有效将其分为有效组和无效组, 多因素Logistic回归分析脑外伤患者经鼻高流量氧疗干预无效的危险因素, 并根据分析结果建立预测模型, 验证其有效性。 结果 480 例脑外伤患者经鼻高流量氧疗干预后无效 69 例 (14.38%), 设为无效组; 其余 411 例 (85.62%) 均有效, 设为有效组。多因素 Logistic 回归分析结果显示, PaO2/ FiO2 、GCS 评分、SOFA 评分、APACHEⅡ评分、BNP 水平为脑外伤患者经鼻高流量氧疗干预无效的独立影响因素 (95%CI为0.052 ~ 0.703、0.052 ~ 0.60、1.828 ~ 21.860、1.429 ~18.417、1.744~ 16.808, P= 0.013、0.006、0.004、0.012、0.004)。建立预测模型公式为 Logit (P)=-4.895-1.652×PaO2/ FiO2-1.725×GCS分+1.844×SOFA分+1.635×APACHEⅡ评分+1.689×BNP水平。受试者操作特征 (ROC) 曲线分析结果显示, 当截断值为 1.78 时, 预测模型预测脑外伤患者经鼻高流量氧疗干预无效的灵敏度为 87.4%、特异度为 80.6%、阳性预测值为 70.3%, 阴性预测值为95.1%,且Hosmer-Lemeshow 卡方检验结果显示, χ2 = 5.951, P= 0.586。结论 根据 PaO2/ FiO2、GCS评分、SOFA评分、APACHEⅡ评分以及BNP水平建立的预测模型对脑外伤患者经鼻高流量氧疗干预无效的预测效果理想、区分性能良好。 |
| 英文摘要: |
| 【Abstract】 Objective To establish and validate the prediction model for ineffective intervention of nasal high-flowoxygen therapy in patients with traumatic brain injury. Methods 480 patients with traumatic brain injury admitted to Nanyang First People’s Hospital from February 2019 to March 2023 underwent nasal high-flow oxygen therapy were selected as the research subjects to collect data of the arterial partial pressure of oxygen / arterial partial pressure of carbon dioxide (PaO2/ PaCO2 ), partial pressure of oxygen in arterial blood / fractional concentration of inspiratory oxygen (PaO2/ FiO2 ) ,Glasgow coma scale (GCS) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, pH value, and levels of lactate, brain natriuretic peptide (BNP), C-reactive protein (CRP) and procalcitonin (PCT), and the application of nasal high-flow oxygen therapy. The patients were divided into the effective group and the ineffective group according to whether the therapy was effective or not. Multivariate Logistic regression was conducted to analyze the risk factors of ineffectiveness of the nasal high-flow oxygen therapy in patients with traumatic brain injury, and a prediction model was established according to the analysis results to verify its effectiveness. Results Of the 480 patients with traumatic brain injury receiving the nasal high-flow oxygen therapy, 69 cases (14.38%) showing treatment ineffectiveness, were set as the ineffective group, and the left 411 cases (85.62%) showed treatment effectiveness, being set as the effective group. The results of multivariate Logistic regression showed that PaO2/ FiO2 , GCS score, SOFA score, APACHE II score, and BNP level were independent risk factors for ineffectiveness of the nasal high-flow oxygentherapy in patients with traumatic brain injury (95%CI: 0.052-0.703, 0.052-0.607, 1.828-21.860, 1.429-18.417,1.744-16.808, P= 0.013, 0.006, 0.004, 0.012 and 0.004). The predictive model equation was Logit (P) = -4.895-1.652×PaO2 / FiO2-1.725×GCS score+1.844×SOFA score+1.635×APACHEⅡ score+1.689×BNP level. The results of receiver operating characteristic (ROC) curve analysis showed that when the cut-off value was 1.78, the predictive model had a sensitivity of 87.4%, a specificity of 80.6%, a positive predictive value of 70.3%, and a negative predictive value of 95.1% to predict the ineffectiveness of the nasal high-flow oxygen therapy in patients with traumatic brain injury. And Hosmer-Lemeshow chi-square test results showed χ2 = 5.951, P= 0.586. Conclusion The prediction model established according to the independent risk factors of PaO2/ FiO2 , GCS score, SOFA score, APACHEⅡ score and BNP level has ideal prediction effect and good discrimination performance for the ineffective application of the nasal high-flow oxygen therapy in patients with traumatic brain injury. |
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