作者：周媛 ，黄洪鑫 ，李立新

单位：

1.210029江苏省南京市，南京医科大学第一附属医院麻醉与围手术期医学科　2.210029江苏省南京市，南京医科大 学第一临床医学院　3.210029江苏省南京市，南京医科大学第一附属医院神经外科

Units：

1.Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China 2.The First Medical College of Nanjing Medical University, Nanjing 210029, China 3.Department of Neurosurgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China

关键词：

三叉神经痛；经皮穿刺球囊压迫术；血流动力学；影响因素分析；列线图

Keywords：

Trigeminal neuralgia; Percutaneous balloon compression; Hemodynamics; Root cause analysis; Nomograms

CLC：

R 745.11

DOI：

10.12114/j.issn.1008-5971.2023.00.279

Funds：

国家自然科学基金资助项目（82203767）；江苏省科技项目（BK20201077）

摘要：

目的　分析三叉神经痛（TN）患者经皮穿刺球囊压迫术（PBC）中发生严重血流动力学波动的影响 因素，并构建其风险预测列线图模型。方法　回顾性选取2020—2022年在南京医科大学第一附属医院接受PBC的TN 患者60例为研究对象。收集患者的一般资料，根据患者PBC中严重血流动力学波动发生情况将其分为发生组和未发生 组。采用多因素Logistic回归分析探讨TN患者PBC中发生严重血流动力学波动的影响因素；基于多因素Logistic回归分 析结果，构建TN患者PBC中发生严重血流动力学波动的风险预测列线图模型；采用ROC曲线分析该列线图模型的预 测效能，采用校准曲线分析该列线图模型的准确性。结果　60例患者中，发生严重血流动力学波动22例（36.7%）。 发生组男性占比、有饮酒史者占比低于未发生组，年龄大于未发生组，BMI、有高血压史者占比高于未发生组，病 程长于未发生组（P＜0.05）。多因素Logistic回归分析结果显示，年龄、高血压史是TN患者PBC中发生严重血流动力 学波动的影响因素（P＜0.05）。基于多因素Logistic回归分析结果，构建TN患者PBC中发生严重血流动力学波动的 风险预测列线图模型。ROC曲线分析结果显示，该列线图模型预测TN患者PBC中发生严重血流动力学波动的AUC为 0.860〔95%CI（0.763，0.957）〕。校准曲线分析结果显示，该列线图模型预测TN患者PBC中发生严重血流动力学波 动的校准曲线接近于理想曲线。结论　年龄增长、有高血压史是TN患者PBC中发生严重血流动力学波动的危险因素， 本研究基于上述危险因素构建的列线图模型对TN患者PBC中发生严重血流动力学波动有较好的预测价值。

Abstract：

Objective To analyze the influencing factors of severe hemodynamic fluctuations in patients with trigeminal neuropathy (TN) during percutaneous balloon compression (PBC) , and construct a nomogram model for predicting its risk. Methods Sixty patients with TN who received PBC in the First Affiliated Hospital with Nanjing Medical University from 2020 to 2022 were retrospectively selected as the study objects. The general data of patients were collected. According to the occurrence of severe hemodynamic fluctuations during PBC, the patients were divided into occurrence group and non-occurrence group. Multivariate Logistic regression analysis was used to investigate the influencing factors of severe hemodynamic fluctuations in TN patients during PBC. Based on the results of multivariate Logistic regression analysis, the nomogram model for predicting the risk of severe hemodynamic fluctuations in TN patients during PBC was constructed. ROC curve was used to analyze the prediction efficiency of the nomogram model, and calibration curve was used to analyze the accuracy of the nomogram model. Results Among the 60 patients, 22 (36.7%) experienced severe hemodynamic fluctuations. The proportion of men and the proportion of patients with drinking history in the occurrence group were lower than those in the non-occurrence group, the age was older than that in the non-occurrence group, the BMI and the proportion of patients with hypertension history were higher than those in the non-occurrence group, and the course of the disease was longer than that in the non-occurrence group (P < 0.05) . Multivariate Logistic regression analysis showed that age and history of hypertension were the influencing factors for severe hemodynamic fluctuations in TN patients during PBC (P < 0.05) . Based on the results of multivariate Logistic regression analysis, the nomogram model for predicting the risk of severe hemodynamic fluctuations in TN patients during PBC was constructed. ROC curve analysis showed that the AUC of the nomogram model in predicting severe hemodynamic fluctuations in TN patients during PBC was 0.860 [95%CI (0.763, 0.957) ] . The calibration curve analysis results showed that the calibration curve of the nomogram model in predicting severe hemodynamic fluctuations in TN patients during PBC was close to the ideal curve. Conclusion Increased age and history of hypertension are risk factors for severe hemodynamic fluctuations in TN patients during PBC. The nomogram model constructed based on these risk factors has good predictive value for the occurrence of severe hemodynamic fluctuations in TN patients during PBC.

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