实用医学杂志 ›› 2022, Vol. 38 ›› Issue (22): 2807-2812.doi: 10.3969/j.issn.1006⁃5725.2022.22.008

• 临床研究 • 上一篇    下一篇

高血压脑出血术后行持续腰大池外引流继发癫痫的危险因素

蒋帅1 孙美蓉2 孙波1 张西安1 刘展会1 侯鹏飞1    

  1. 1 西安市第九医院神经外科(西安 710054);2 西安市中心医院妇产科(西安 710004)

  • 出版日期:2022-11-25 发布日期:2022-11-25
  • 通讯作者: 侯鹏飞 E⁃mail:louzi15111@163.com
  • 基金资助:
    陕西省重点研发计划项目(编号:2018SF⁃093);西安市第九医院临床研究项目(编号:2020⁃13)


Risk factors of epilepsy after continuous lumbar cistern drainage after hypertensive intracerebral hemor⁃ rhage

JIANG Shuai*,SUN Meirong,SUN Bo,ZHANG Xi′an,LIU Zhanhui,HOU Pengfei.   

  1. Department of Neu⁃ rosurgery,the Ninth Hospital of Xi′an,Xi′an 710054,China

  • Online:2022-11-25 Published:2022-11-25
  • Contact: HOU Pengfei E⁃mail:louzi15111@163.com

摘要:

目的 探究高血压脑出血(HICH)患者术后行持续腰大池外引流继发癫痫(EP)的危险因素。方法 回顾性分析 2018 10 月至 2021 1 月于我院治疗的 356 HICH 患者的临床资料,根据是否继发 EP 分成发生组(52 例)和未发生组(304 例)。采用 LASSO logistic 回归分析 HICH 患者继发 EP 独立危险因素,并构建列线图预测模型。采用受试者工作曲线(ROC)评价模型的区分度、校准曲线评价 其准确度。结果 单因素分析和多因素 logistic 回归分析结果显示,高血压病程、血肿体积、引流管污染、 术后再出血、肿瘤坏死因子⁃α(TNF⁃α)、白细胞介素⁃6(IL⁃6)、神经元特异性烯醇化酶(NSE)是 HICH 患者 术后行持续腰大池外引流继发 EP 的独立危险因素(P < 0.05)。验证结果显示,训练集和验证集的 C⁃index 分别为 0.880(95% CI:0.833 ~ 0.921)、0.870(95% CI:0.825 ~ 0.922),ROC 曲线下面积(AUC)分别为 0.884 (95% CI:0.828 ~ 0.941)、0.869(95% CI:0.790~0.915)。列线图模型拟合效果良好,区分度和准确度较高。 结论 高血压病程、血肿体积、引流管污染、术后再出血、TNF⁃α、IL⁃6、NSE HICH 患者术后行持续腰大 池外引流继发EP 的独立危险因素(P < 0.05)。

关键词:

高血压脑出血, 腰大池外引流, 癫痫, 危险因素, 列线图

Abstract:

Objective To explore the risk factors of epilepsy after continuous lumbar cistern drainage in hypertensive cerebral hemorrhage(HICH)patients. Methods According to whether they developed secondary epilepsy or not,the clinical data of 356 HICH patients treated in our hospital from October 2018 to January 2021 were retrospectively evaluated. They were split into the occurrence group(52 cases)and the non⁃occurrence group (304 cases).Independent risk factors for secondary epilepsy in HICH patients were screened by LASSO and Logistic regression analysis.,and a nomogram prediction model was constructed. The discrimination and calibration curve of the model were evaluated by the receiver operating curve(ROC). Results Univariate analysis and multivariate logistic regression analysis showed that the course of hypertension,hematoma volume,drainage tube pollution, postoperative rebleeding,tumor necrosis factor ⁃ α(TNF ⁃ α),Interleukin ⁃6(IL ⁃6)and neuron specific enolase (NSE)were independent risk factors of epilepsy after continuous lumbar cistern drainage in HICH patients(< 0.05). The verification results show that the c⁃index of the training set and the verification set are 0.880(95% CI: 0.833 ~ 0.921),0.870(95% CI:0.825 ~ 0.922),and the area under the ROC curve(AUC)are 0.884(95% CI: 0.828 ~ 0.941)and 0.869(95% CI:0.790 ~ 0.915)respectively. The nomogram model has strong accuracy,high discrimination,and good fitting. Conclusions Following continuous lumbar cistern drainage in these HICH patients,hypertension course,hematoma volume,drainage tube pollution,postoperative rebleeding,TNF⁃α,IL⁃6, and NSE were independent risk factors for epilepsy(< 0.05).

Key words:

hypertensive cerebral hemorrhage, hrainage terminal cistern, epilepsy, risk factor, nomogram