摘要
目的探讨脑血管介入术后患者股动脉穿刺处血肿的危险因素,构建其风险预测模型并进行验证。方法选取2018年7月至2023年7月于空军军医大学第一附属医院神经外科行脑血管介入术的743例患者的临床资料进行回顾性分析,根据患者是否发生术后股动脉穿刺处血肿,分为发生血肿组和未发生血肿组,将单因素分析中P<0.05的因素纳入Logistic回归分析,构建血肿风险预测模型,应用受试者工作特征(ROC)曲线下面积(AUC)和Hosmer-Lemeshow拟合优度检验分别评价模型的区分度和校准度。采用Bootstrap方法进行内部验证,纳入2019年6月至2023年7月在西安交通大学第二附属医院神经外科行脑血管介入术的258例患者,对模型进行外部验证。结果饮酒史、高血压史、体质量指数(BMI)、穿刺部位、术中使用抗凝药物是脑血管介入术后患者股动脉穿刺处血肿的独立危险因素,模型预测公式为Y=-4.487+2.284×饮酒史+0.984×高血压史(≤5年)+1.465×高血压史(>5年)+1.234×BMI(>24)+2.617×穿刺部位(双侧)+2.819×术中使用抗凝药物(使用1种)+2.815×术中使用抗凝药物(使用2种或以上),ROC曲线下面积为0.881,敏感度为0.769,特异度为0.85,约登指数为0.619,Hosmer-Lemeshow拟合优度检验P=0.374(χ^(2)=8.633),表明该模型具有较好的预测价值。内部验证的ROC曲线下面积为0.887(95%CI:0.849~0.925),敏感度为0.938,特异度为0.638,Hosmer-Lemeshow检验P=0.791(χ^(2)=4.678);外部验证ROC曲线下面积为0.921(95%CI:0.847~0.995),敏感度为0.902,特异度为0.769,Hosmer-Lemeshow检验P=0.198(χ^(2)=8.590)。校准曲线提示列线图模型内外部验证的平均绝对误差均小于0.05。结论基于饮酒史、高血压史、BMI、穿刺部位、术中使用抗凝药物构建的预测模型效能良好,该模型可对脑血管介入术后患者发生穿刺处血肿进行早期识别,为降低经股动脉介入术后穿刺处血肿的发生率提供参考。
Objective To investigate risk factors for hematoma at the femoral artery puncture site after cerebrovascular intervention and to construct and validate a risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 743 patients who underwent cerebrovascular intervention at the Department of Neurosurgery,the First Affiliated Hospital of the Air Force Medical University,from July 2018 to July 2023.These patients were divided into hematoma and non-hematoma groups based on the occurrence of post-operative hematoma.Factors with P<0.05 in univariate analysis were included in logistic regression to construct a hematoma risk prediction model.The model's discrimination and calibration were evaluated using the area under the ROC curve and Hosmer-Lemeshow goodness-of-fit test.Internal validation was performed using the Bootstrap method,and external validation involved 258 patients from the Second Affiliated Hospital of Xi'an Jiaotong University from June 2019 to July 2023.Results Alcohol history,hypertension history,BMI,puncture site,and intraoperative anticoagulant use were independent risk factors.The prediction model formula is Y=-4.487+2.284(alcohol history)+0.984(hypertension history≤5 years)+1.465(hypertension history>5 years)+1.234(BMI>24)+2.617(bilateral puncture site)+2.819(1 anticoagulant)+2.815(≥2 anticoagulants).The area under the ROC curve was 0.881,with sensitivity 0.769,specificity 0.85,and Youden index 0.619.Hosmer-Lemeshow test P=0.374(χ^(2)=8.633)indicated good predictive value.Internal validation showed AUC=0.887(95%CI:0.849-0.925),sensitivity 0.938,specificity 0.638,Hosmer-Lemeshow P=0.791(χ^(2)=4.678).External validation showed AUC 0.921(95%CI:0.847-0.995),sensitivity 0.902,specificity 0.769,Hosmer-Lemeshow P=0.198(χ^(2)=8.590).Calibration curves indicated an average absolute error<0.05 for both internal and external validation.Conclusion The prediction model based on alcohol history,hypertension history,BMI,puncture site,and intraoperative anticoagulant use demonstrates good performance and can facilitate early identification of hematoma at puncture sites post-cerebrovascular intervention,providing a reference for reducing hematoma incidence after femoral artery intervention.
作者
王娟
郝佩
贺养敏
张洪晨
徐岁云
李侠
鲁传豪
WANG Juan;HAO Pei;HE Yangmin;ZHANG Hongchen;XU Suiyun;LI Xia;LU Chuanhao(Department of Neurosurgery,the First Affiliated Hospital of the Air Force Medical University,Xi’an,Shaanxi 710032,China;Department of Neurosurgery,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi’an,Shaanxi 710004,China)
出处
《中华神经外科疾病研究杂志》
2025年第4期41-47,共7页
Chinese Journal of Neurosurgical Disease Research
关键词
脑血管介入术
股动脉穿刺
血肿
危险因素
预测模型
Cerebrovascular intervention
Femoral artery puncture
Hematoma
Risk factors
Prediction model
作者简介
王娟,E-mail:280025724@qq.com;通信作者:鲁传豪,E-mail:sd3t@163.com。
