预测脑部肿瘤开颅术后神经并发症分数
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Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy
背景与目的
脑部肿瘤开颅的发病率和死亡率较高，但是却没有适用于辨别高危患者的评分。我们的目的是验证一种在这种情况下神经外科术后并发症的预测得分。
方 法
研究纳入一个中心里从2008年至2012年接受择期脑瘤开颅手术共1094名患者的前瞻性特定数据库，在研究队列中得到一个分数。对在2013 - 2015年法国6所大学医院830例多中心独立队列进行验证。主要结局变量是需要重症监护病房处理的术后神经并发症(颅内高血压、颅内出血、癫痫持续状态、呼吸衰竭、意识受损、意外运动障碍)。采用结合Lasso (least absolute shrinkage and selec-tion operator)建模方法对潜在风险因素进行logistic回归选择。
结 果
在研究组和验证组中，分别有125例(11.4%)和90例(10.8%)患者发生严重并发症。相关的严重并发症的独立危险因素患者(手术前格拉斯哥昏迷评分达到或者低于14,脑部肿瘤手术史),肿瘤特点(最大直径,大脑中线移位至少3毫米),和围手术期管理(输血的血液制品,最大和最小收缩期动脉压力,手术持续时间)。在研究队列中，得分在3%或以下的阳性预测值为12.1%，阴性预测值为100%。在重症监护病房中，在研究组和验证组中分别有8名(死亡率0.7%)和6名患者死亡(死亡率0.7%)。
结 论
验证预测得分是按需进入重症监护病房的第一步。在日常使用前，还需要进一步的研究来提高得分。
原始文献摘要
Lonjaret L, Guyonnet M, Berard E, et al. Postoperative complications after craniotomy for brain tumour surgery[J]. Anaesthesia Critical Care & Pain Medicine, 2016, 36(4).
Background: Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting.
Methods: Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression.
Results: Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively.
Conclusions: The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score s performance before routine use.
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贵州医科大学高鸿教授课题组
编辑：余晓旭 审校：王贵龙