贵州医科大学学报

2020, v.45;No.241(10) 1219-1224

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老年急性脑出血并发相关性肺炎的危险因素分析及风险预测模型的建立
Analysis of Risk Factors of Senile Acute Cerebral Hemorrhage Complicated with Associated Pneumonia and Establishment of Risk Prediction Model

吴倩;路伟;
WU Qian;LU Wei;Department of Emergency,Beijing Tiantan Affiliated Hospital of Capital Medical University;Department of Digestive System,the 1stAffiliated Hospital of Air Force Medical University;

摘要(Abstract):

目的:探讨老年急性脑出血并发相关性肺炎(SAP)的危险因素及风险预测模型的建立。方法:173例因急性脑出血入院的老年患者,根据是否发生SAP分为SAP组(n=44)和非SAP组(n=129),采用单因素方差分析2组患者性别、年龄、体质量指数(BMI)、吸烟史、高血压、糖尿病、冠心病、肺部基础疾病史、吞咽困难、入院时美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GSC)评分、血肿初始体积、侵入性气道操作、鼻饲治疗、应用抗生素、应用糖皮质激素及预防性使用抑酸剂,采用Logistic多元回归分析SAP的独立危险因素,并建立相关列线图预测模型。结果:单因素方差分析结果显示,2组患者的年龄、肺部基础疾病史、吞咽困难、入院NIHSS评分、侵入性气道操作、鼻饲治疗及预防性使用抑酸剂的资料差异有统计学意义(P <0.05); Logistic回归多因素分析显示,年龄≥70岁、肺部基础疾病史、吞咽困难、入院NIHSS评分≥10分、侵入性气道操作、鼻饲治疗及预防性使用抑酸剂是老年急性脑出血患者发生SAP的独立危险因素(P <0.05);列线图模型验证显示,发生SAP预测值同实测值基本一致,C-index指数为0.843(95%CI为0.811~0.875)。结论:年龄≥70岁、肺部基础疾病史、吞咽困难、入院NIHSS评分≥10分、侵入性气道操作、鼻饲治疗及预防性使用抑酸剂是老年急性脑出血患者发生SAP的独立危险因素,建立的列线图预测模型对发生SAP有较准确的预测能力和区分度。
Objective: To investigate the risk factors and risk prediction models for senile patients with acute cerebral hemorrhage complicated with associated pneumonia( SAP). Methods: 173 senile patients admitted to hospital for acute cerebral hemorrhage were selected in this study and further divided into SAP group( n = 44) and non-SAP group( n = 129). Adopting single factor variance to analyze both groups following indexes: age,gender,BMI,history of smoking,hypertension,diabetes,coronary disease,history of pulmonary underlying disease,dysphagia,NIHSS score when admitted to hospital,GSC scores,initial size of hematoma,operation on invasive respiratory passage,nasal feed treatment,anti-biotics application,glucocorticoid application,and preventive use of antacid; Logistic regression multi-variate analysis was used to analyze the independent risk factors and establish relevant nomogram prediction model. Results: Univariate variance results showed that differences in age,history of underlying pulmonary disease,dysphagia,NIHSS admission scores,operation on invasive respiratory passage, nasal feeding treatment, and prophylactic use of antacids were statistically significant between the two groups( P < 0. 05). Logistic regression multivariate analysis showed that over 70 years old,history of underlying pulmonary disease,dysphagia,admission NIHSS scores ≥10,invasive respiratory passage manipulation,nasal feeding treatment,and prophylactic use of antacids are independent risk factors of SAP in elderly patients with acute cerebral hemorrhage( P < 0. 05). The verification of the nomogram model showed that the predicted value is basically consistent with the measured value,and the C-index index was as high as 0. 843( 95% CI was 0. 811 ~ 0. 875).Conclusion: Over 70 years old,history of underlying lung disease,dysphagia,admission NIHSS ≥10 points,invasive respiratory passage operation, nasal feeding treatment, and prophylactic use of antacids are independent risk factors for SAP in elderly patients with acute cerebral hemorrhage. The nomogram prediction model established by the author has accurate prediction ability and differentiation.

关键词(KeyWords): 危险因素;老年患者;急性脑出血;相关性肺炎;风险模型;列线图
risk factors;elderly patients;acute cerebral hemorrhage;associated pneumonia;risk model;nomogram

Abstract:

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作者(Author): 吴倩;路伟;
WU Qian;LU Wei;Department of Emergency,Beijing Tiantan Affiliated Hospital of Capital Medical University;Department of Digestive System,the 1stAffiliated Hospital of Air Force Medical University;

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DOI: 10.19367/j.cnki.2096-8388.2020.10.018

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