摘要
目的 分析小儿单纯性硬膜外血肿(SEDH)保守治疗的临床效果及建立血肿吸收预测模型。方法 2023年8月~2025年3月行保守治疗的SEDH患儿218例。依据保守治疗后血肿吸收状况分为血肿吸收慢组(82例)和血肿吸收快组(136例)。比较两组患儿临床资料。Logistic回归分析影响保守治疗SEDH患儿血肿吸收的危险因素。构建基于保守治疗SEDH患儿血肿吸收预测的列线图模型,并用Bootstrap法进行内部验证,分析风险列线图模型对保守治疗SEDH患儿血肿吸收的预测效能。结果 伤后21天,血肿吸收速度<0.62 ml/d 82例(37.61%,82/218)。血肿吸收慢组年龄为(10.43±1.93)岁、血肿体积为(22.09±3.96) ml、血肿最大厚度(5.92±1.48) mm、入院时格拉斯格昏迷评分(GCS)为(13.33±0.55)分,活化部分凝血酶时间为(30.96±8.94)秒,纤维蛋白原为(2.14±0.58) g/L;吸收快组分别为(7.60±1.53)岁、(12.30±4.13) ml、(3.18±1.06) mm、(14.48±0.48)分、(28.63±7.46)秒和(2.33±0.62) g/L,两组比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、血肿体积、血肿最大厚度是影响保守治疗SEDH患儿血肿吸收的危险因素(P<0.05)。依据多因素分析结果构建列线图模型,校正曲线表明该模型拟合度较好。列线图模型预测SEDH患儿血肿吸收的灵敏度为89.02%(95%CI:79.71%~94.55%),特异度为91.91%(95%CI:85.65%~95.69%),曲线面积(AUC)为0.958(95%CI:0.923~0.981)。结论 基于年龄、血肿体积、血肿最大厚度因素构建的列线图模型,对SEDH患儿血肿吸收的预测效能较好。
Objective To analyze the clinical effect of conservative treatment of 218 cases of simple epidural hematoma(SEDH)in children and establish the prediction model of hematoma absorption.Methods The clinical data of 218 children with SEDH who were treated conservatively in our hospital from August 2023 to March 2025 were analyzed retrospectively.According to the status of hematoma absorption after conservative treatment,the patients were divided into slow hematoma absorption group(n=82)and fast hematoma absorption group(n=136).The clinical data of children with slow hematoma absorption group and fast hematoma absorption group were compared.Logistic regression analysis was used to explore the risk factors of hematoma absorption in children with conservative treatment of SEDH.A nomogram model based on the prediction of hematoma absorption in children with SEDH treated conservatively was constructed and verified internally by Bootstrap method.To analyze the predictive efficacy of risk nomogram model for hematoma absorption in children with SEDH treated conservatively.Results 21 days after injury,37.61%(82/218)of SEDH patients had a hematoma absorption rate of<0.62 ml/d after conservative treatment.The slow hematoma absorption group had an average age of(10.43±1.93)years,hematoma volume of(22.09±3.96)ml,maximum hematoma thickness of(5.92±1.48)mm,admission Glasgow Coma Scale(GCS)score of(13.33±0.55),activated partial thromboplastin time(APTT)of(30.96±8.94)seconds,and fibrinogen level of(2.14±0.58)g/L.In contrast,the fast absorption group showed corresponding values of(7.60±1.53)years,(12.30±4.13)ml,(3.18±1.06)mm,(14.48±0.48)points,(28.63±7.46)seconds,and(2.33±0.62)g/L.The differences between the two groups were statistically significant(P<0.05).Logistic regression analysis identified age,hematoma volume,and maximum hematoma thickness as risk factors influencing hematoma absorption(P<0.05).According to the results of multi-factor analysis,the nomogram model was constructed,and the calibration curve shows that the model has good fitting degree.The sensitivity of the nomogram model for predicting hematoma absorption in children with SEDH was 89.02%(95%CI:79.71%-94.55%),the specificity was 91.91%(95%CI:85.65%-95.69%),and the area under curve(AUC)was 0.958(95%CI:0.923-0.981).Conclusion The nomogram model based on factors such as age,hematoma volume,and maximum hematoma thickness of hematoma has a good predictive effect on hematoma absorption in SEDH children.
作者
冯松林
邓琳
赵丹
何文飞
张涛
FENG Songlin;DENG Lin;ZHAO Dan;HE Wenfei;ZHANG Tao(Department of Pediatric Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;不详)
出处
《临床外科杂志》
2025年第11期1143-1147,共5页
Journal of Clinical Surgery
基金
四川省医学会课题(编号S21059)。
关键词
小儿
单纯性硬膜外血肿
保守治疗
临床效果
血肿吸收
列线图
预测模型
children
simple epidural hematoma
conservative treatment
clinical effect
hematoma absorption
nomogram
prediction model
