摘要
目的构建并验证心脏骤停患者复苏成功后院内死亡的风险预测模。方法回顾性选取接受心肺复苏后成功恢复自主循环并住院进一步治疗的295例心脏骤停患者作为研究对象,通过K-fold交叉验证分为训练集和验证集,再根据是否发生院内死亡分组并比较。采用二分类Logistic回归分析法筛选风险预测因子,构建列线图预测模型,在训练集与验证集中分别评价与验证模型性能。结果多因素Logistic回归分析结果显示,住院时间(OR=1.180,95%CI:1.080~1.280,P<0.001)、去甲肾上腺素剂量(OR=0.980,95%CI:0.970~0.990,P=0.002)、复苏后初始呼吸频率(OR=1.090,95%CI:1.030~1.150,P=0.004)、复苏后窦性心律恢复情况(OR=4.280,95%CI:1.670~10.980,P=0.003)是院内死亡的独立影响因素。根据独立影响因素构建列线图模型,经验证,该模型的区分度、校准度、适用度及合理度均良好。结论心脏骤停患者复苏成功后院内死亡的影响因素包括住院时间、去甲肾上腺素剂量、复苏后初始呼吸频率和复苏后窦性心律恢复情况,据此构建的列线图模型可为临床决策提供参考。
Objective To construct and validate a risk prediction model for in-hospital death af-ter successful resuscitation in patients with cardiac arrest.Methods A retrospective study was con-ducted on 295 patients with cardiac arrest who successfully restored spontaneous circulation after car-diopulmonary resuscitation and were further treated in hospital.The patients were divided into training and validation sets using K-fold cross-validation and then grouped and compared based on whether in-hospital death occurred.A binary Logistic regression analysis was used to screen risk prediction fac-tors,and a nomogram prediction model was constructed.The model performance was evaluated and validated in the training and validation sets,respectively.Results The results of the multivariate Logistic regression analysis showed that hospitalization duration(OR=1.180;95%CI,1.080 to 1.280;P<0.001),norepinephrine dose(0R=0.980;95%CI,0.970 to 0.990;P=0.002),ini-tial respiratory rate after resuscitation(0R=1.090;95%CI,1.030 to 1.150;P=0.004),and sinus rhythm recovery after resuscitation(0R=4.280;95%CI,1.670 to 10.980;P=0.003)were inde-pendent influencing factors for in-hospital death.A nomogram model was constructed based on these in-dependent influencing factors,and it was verified that the model had good discrimination,calibration,applicability,and rationality.Conclusion The influencing factors for in-hospital death after successful resuscitation in patients with cardiac arrest include hospitalization duration,norepinephrine dose,initial respiratory rate after resuscitation,and sinus rhythm recovery after resuscitation.The nomo-gram model constructed based on these factors can provide a reference for clinical decision-making.
作者
李玉
陈阵
郭鑫
梁依凡
王珏艳
李锦磊
杨先婷
艾芬
LI Yu;CHEN Zhen;GUO Xin;LIANG Yifan;WANG Jueyan;LI Jinlei;YANG Xianting;AI Fen(Medical Department,Jianghan University,Wuhan,Hubei,430113;Department of Emergency Medicine,Wuhan Central Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430014;Cardiovascular Department,Wuhan Central Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430014)
出处
《实用临床医药杂志》
2025年第11期26-32,41,共8页
Journal of Clinical Medicine in Practice
基金
湖北省科技厅自然科学基金资助项目(2024AFB893)。
关键词
心脏骤停
心源性猝死
心肺复苏
自主循环恢复
院内死亡
列线图模型
窦性心律
去甲肾上腺素
cardiac arrest
sudden cardiac death
cardiopulmonary resuscitation
return of spontaneous circulation
in-hospital death
nomogram model
sinus rhythm
norepinephrine
