脑损伤后意识障碍患者意识恢复影响因素的Logistic回归分析

发布时间：2019-03-10 20:50

【摘要】：目的探讨脑损伤后意识障碍患者意识恢复的影响因素。方法回顾性分析114例脑损伤后意识障碍患者临床资料,采用二元Logistic回归法对可能影响意识恢复的因素进行分析并建立回归模型,绘制ROC曲线,确定预后模型的最佳临界值。结果单因素分析结果显示植物状态持续时间(P0.001)、入院时昏迷恢复量表(CRS-R)评分(P0.001)、脑积水(P=0.037)、肌张力高(P=0.034)、中枢性发热(P=0.035)、阵发性交感神经过度兴奋(P=0.004)与意识恢复相关。Logistic回归分析显示中枢性发热(OR=3.493,P=0.044)、植物状态持续时间(OR=1.016,P=0.008)、阵发性交感神经过度兴奋(OR=4.223,P=0.034)及入院时CRS-R评分(OR=0.640,P=0.002)是意识恢复的独立影响因素。该模型Hosmer-Lemeshow检验的χ~2值为10.214(P=0.250),预测概率ROC曲线下面积为0.91,提示该模型拟合优度很好。结论阵发性交感神经过度兴奋的出现是影响意识障碍患者意识恢复的首要因素;中枢性发热的出现,入院时CRS-R评分较差,植物状态持续时间过长是影响意识恢复的次要因素。
[Abstract]:Objective to explore the influencing factors of consciousness recovery in patients with consciousness disorder after brain injury. Methods the clinical data of 114 patients with consciousness disorder after brain injury were retrospectively analyzed. The factors that might affect the recovery of consciousness were analyzed by binary Logistic regression method and the regression model was established. The ROC curve was drawn to determine the optimal critical value of the prognosis model. Results univariate analysis showed that the duration of vegetative state (P0.001), coma recovery scale (CRS-R) on admission (P0.001), hydrocephalus (P0. 037), muscular tension (P0. 034), central fever (P0. 035) were observed. Paroxysmal sympathetic hyperexcitation (P0. 0004) was associated with recovery of consciousness. Logistic regression analysis showed central fever (OR=3.493,P=0.044) and vegetative state duration (OR=1.016,P=0.008). Paroxysmal sympathetic hyperexcitation (OR=4.223,P=0.034) and CRS-R score (OR=0.640,P=0.002) on admission were independent factors influencing the recovery of consciousness. The 蠂 ~ 2 value of the Hosmer-Lemeshow test of the model is 10.214 (P = 0.250) and the area under the prediction probability ROC curve is 0.91, which indicates that the model has a good fit degree. Conclusion the occurrence of paroxysmal sympathetic hyperexcitation is the primary factor affecting the recovery of consciousness in patients with consciousness disorder. The occurrence of central fever, the poor CRS-R score on admission, and the long duration of vegetative state were the secondary factors affecting the recovery of consciousness.
【作者单位】：广州中医药大学;广州总医院神经康复一科;
【基金】：国家自然科学基金(81371535)
【分类号】：R651.15

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