张晓慧,李一,李和平,等.脑干出血患者吞咽功能恢复的影响因素分析及预测模型构建[J].中华物理医学与康复杂志,2025,47(5):440-445
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| 脑干出血患者吞咽功能恢复的影响因素分析及预测模型构建 |
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| DOI：10.3760/cma.j.cn421666-20240418-00290 |
| 中文关键词: 脑干出血 吞咽障碍 预测模型 影响因素 |
| 英文关键词: Brainstem hemorrhage Dysphagia Prediction models |
| 基金项目:中国康复医学会科技发展项目(KFKT-2023-029) ；河南省科技厅重点研发专项（241111310600） |
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| 中文摘要: |
| 目的 探讨影响脑干出血患者吞咽功能恢复的相关因素并构建预测模型。 方法 采用回顾性调查方法收集符合标准的134例脑干出血伴吞咽障碍患者的临床资料。根据出院时吞咽功能是否恢复将上述患者分为吞咽功能恢复组和未恢复组，通过单因素相关分析及多因素logistic回归分析，探讨影响脑干出血患者吞咽功能结局的独立因素，并构建列线图预测模型。采用受试者工作特征（ROC）曲线分析相关影响因素及预测模型对脑干出血患者吞咽功能结局的预测价值。 结果 共有62例患者（占46%）在出院时恢复吞咽功能并将其纳入恢复组，余72例患者（占54%）则纳入未恢复组。单因素相关分析显示，2组患者在脑出血治疗措施、是否气管插管、美国国立卫生研究院卒中量表(NIHSS)评分、功能性经口摄食量表(FOIS)评分、Barthel指数评分及格拉斯哥昏迷量表（GCS）评分方面组间差异均具有统计学意义（P<0.05）。多因素logistic回归分析显示，低NIHSS评分、高FOIS评分、高GCS评分是脑干出血患者吞咽功能恢复的独立保护因素。联合上述3项指标构建预测脑干出血患者吞咽功能结局的列线图模型，通过分析ROC曲线发现，该预测模型的ROC曲线下面积（AUC）为0.953（95% CI：0.902~0.982），灵敏度为87.10%，特异度为93.06%，其预测效能明显优于NIHSS评分、GCS评分或FOIS评分单独预测。 结论 NIHSS评分、GCS评分及FOIS评分均是影响脑干出血患者吞咽功能恢复的独立因素，且由三者联合构建的列线图模型对脑干出血患者吞咽功能结局具有较好的预测价值。 |
| 英文摘要: |
| Objective To explore the factors influencing the recovery of swallowing function after a brainstem hemorrhage and to construct a prediction model. Methods Clinical data on 134 persons with dysphagia after a brainstem hemorrhage were collected retrospectively. According to their swallowing ability at discharge, the patients were divided into a swallowing recovery group and a non-recovery group. Univariate correlation analysis and multivariate logistic regression analysis were used to explore the independent factors influencing the recovery of swallowing function and to construct a prediction nomogram. The receiver operating characteristics (ROC) curves were evaluated to analyze the nomogram′s predictive value and those of the relevant influencing factors. Results Sixty-two of the patients (46%) had recovered their swallowing function at discharge, while 72 (54%) had not. Univariate correlation analysis showed that there had been significant differences in tracheal intubation, NIHSS score, FOIS score, Barthel index and Glasgow coma scale (GCS )score between the two groups, on average. The multivariate logistic regressions showed that a low NIHSS score, a high FOIS score and a high GCS score were independent predictors of swallowing function recovery, so they were used in the prediction model. ROC curve analysis showed that the area under the curve (AUC) of the prediction model was 0.953 (95% CI：0.902~0.982) with a sensitivity of 87% and a specificity of 93%. The model′s predictions were thus better than using an NIHSS score, GCS score or FOIS score alone. Conclusions NIHSS score, GCS score and FOIS score can independently predict the recovery of swallowing function after a brainstem hemorrhage. A prediction model constructed using all three has good predictive power. |
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