目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料，按照7︰3比例随机化分为训练列（293例）和验证队列（126例）。统计基于开发队列数据，采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素，并构建风险预测模型。基于开发队列和验证队列数据，采用校准曲线、受试者操作特征（ROC）曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎，发生率为26.97%。美国国立卫生研究院卒中量表（NIHSS）评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞计数与淋巴细胞计数比值（NLR）、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素（P＜0.05）。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型，校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近；ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906（95%CI：0.867~0.937）、0.884（95%CI：0.815~0.934）；决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage（ICH）and validate the predictive performance of the model．Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022．They were randomly divided into a development cohort（293 cases）and a validation cohort（126 cases）according to a 7∶3 ratio．The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data，and a risk prediction model was constructed．Based on the development cohort data and validation cohort data，the predictive performance of the model was analyzed using calibration curves，receiver operating characteristic（ROC）curve，and decision curve analysis．Results Among 419 patients，113 developed stroke associated pneumonia，with a rate of 26.97%．The National Institutes of Health Stroke Scale（NIHSS）score，swallowing difficulties，initial hematoma volume，neutrophil percentage to albumin ratio（NPAR），neutrophil count to lymphocyte count ratio（NLR），surgical treatment，endotracheal intubation，and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH（P＜0.05）．Based on the above influencing factors，a risk prediction model for stroke associated pneumonia in patients with ICH was constructed．The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence．The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906（95%CI：0.867-0.937）and 0.884（95%CI：0.815-0.934），respectively．The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%，and the threshold probability of the validation cohort was between 2%-76%，the intervention using this model was more clinically valuable than all/no intervention．

Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score，swallowing difficulties，initial hematoma volume，NPAR，NLR，surgical treatment，tracheal intubation，and indwelling gastric tube has good predictive performance and clinical application value．

【摘要】目的：基于潜类别增长模型（LCGM）探讨脑出血患者神经功能恢复轨迹及不同轨迹对预后的影响。方法：回顾性采集360例自发性脑出血患者（2023年6月～2025年6月）的临床资料及神经功能评分[美国国立卫生研究院卒中量表（NIHSS）]，并采用LCGM识别神经功能恢复轨迹的潜在类别，分析影响恢复不良型轨迹的危险因素，对比不同轨迹的预后情况[改良Rankin量表（mRS）、格拉斯哥预后评分（GOS）]。结果：LCGM模型拟合结果显示，3类轨迹为最优拟合模型，可将360例自发性脑出血患者分为快速恢复型139例（38.61%）、稳定恢复型154例（42.78%）、恢复不良型67例（18.61%）；入院格拉斯哥昏迷量表（GCS）评分、初始NIHSS评分、机械通气、血管活性药物使用及血肿体积是神经功能恢复不良的独立影响因素（P＜0.05）；预后方面，三组患者mRS、GOS评分存在显著差异（P＜0.05）。结论：基于LCGM可有效识别脑出血患者神经功能恢复的异质性轨迹，同时还能明确影响患者神经功能修复的独立危险因素及不同神经功能恢复轨迹与预后的关联。

Abstract Objective: To explore the trajectory of neurological recovery in patients with cerebral hemorrhage and the impact of different trajectories on prognosis based on latent class growth model (LCGM). Methods: The clinical data and neurological function scores [National Institutes of Health Stroke Scale (NIHSS)] of 360 patients with spontaneous cerebral hemorrhage (June 2023 to June 2025) were retrospectively collected, and LCGM was used to identify potential categories of neurological recovery trajectories, analyze risk factors affecting poor recovery trajectories, and compare the prognosis of different trajectories [modified Rankin Scale (mRS), Glasgow Outcome Score (GOS)]. Results: The LCGM model fitting results showed that the three types of trajectories were the optimal fitting model, and 360 patients with spontaneous cerebral hemorrhage could be divided into 139 cases (38.61%) of rapid recovery type, 154 cases (42.78%) of stable recovery type, and 67 cases (18.61%) of poor recovery type; admission to Glasgow Coma Scale (GCS) score, initial NIHSS score, mechanical ventilation, use of vasoactive drugs and hematoma volume are independent influencing factors of poor neurological recovery (P＜0.05); in terms of prognosis, there were significant differences in mRS and GOS scores among the three groups of patients (P＜0.05).Conclusion: Based on LCGM, it is possible to effectively identify the heterogeneous trajectories of neurological function recovery in patients with intracerebral hemorrhage (ICH), while also identifying independent risk factors influencing neurological function repair and establishing associations between different recovery trajectories and prognosis.

       目的 探讨自发性脑出血（SICH）患者静脉血栓栓塞症（VTE）的独立危险因素,并评估针对性分层预防措施的有效性及安全性, 为临床优化防治策略提供依据。方法 回顾性纳入2022年1月—2025年1月收治的86例SICH患者, 根据下肢深静脉超声结果分为深静脉血栓（DVT）组（n=16）与非DVT组（n=70）。采集患者基线资料、临床特征及实验室指标, 采用单因素及多因素Logistic回归分析VTE危险因素, 并基于独立危险因素制定分层预防方案。结果 多因素分析显示, 体质指数（BMI）升高（OR=1.22, 95%CI：1.06~1.41）、中心静脉置管（OR=5.23, 95%CI：1.37~19.95）、止血药物使用（OR=4.80, 95%CI：1.21~19.01）及NIHSS评分升高（OR=1.20, 95%CI：1.02~1.42）是VTE的独立危险因素（均P<0.05）。因此需针对SICH患者进行针对性干预, 包括基于BMI的个体化干预、中心静脉置管的精细化管控、止血药物的动态调控及神经功能保护与早期康复。结论 SICH患者VTE发生与代谢、医源性及神经功能损伤多因素交互作用密切相关, 应针对患者构建基于BMI、中心静脉管理及凝血监测的分层预防策略。

       Objective To explore the independent risk factors for venous thromboembolism（VTE）in patients with spontaneous intracerebral hemorrhage（SICH）and to assess the effectiveness and safety of targeted stratified prophylaxis to provide a basis for optimizing prevention and treatment strategies in the clinic．Methods A retrospective analysis was conducted on 86 SICH patients admitted between January 2022 and January 2025．Based on lower-extremity venous ultrasound findings, patients were divided into a deep venous thrombosis（DVT）group（n=16）and a non-DVT group（n=70）．Baseline characteristics, clinical features, and laboratory indicators were collected．Univariate and multivariate Logistic regression analyses were performed to identify VTE risk factors, and a stratified prevention protocol was developed based on independent risk factors．Results Multivariate analysis revealed that elevated body mass index（BMI）（OR=1.22, 95%CI：1.06-1.41）, central venous catheterization（OR=5.23, 95%CI：1.37-19.95）, hemostatic drug use（OR=4.80, 95%CI：1.21-19.01）, and higher NIHSS scores（OR=1.20, 95%CI：1.02-1.42）were independent risk factors for VTE（all P<0.05）．Consequently, targeted nursing interventions should be implemented for SICH patients, including BMI-based personalized care, refined management of central venous catheters, dynamic regulation of hemostatic drugs, and neuroprotective early rehabilitation．Conclusions VTE in SICH patients is closely associated with the interplay of metabolic, iatrogenic,and neurological injury factors．A stratified prevention strategy incorporating BMI monitoring, central venous catheter management, and coagulation surveillance is critical for reducing thrombotic risk while ensuring safety．

目的 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系, 并应用于临床,为急诊脑出血患者护理质量管理、监测与评价提供客观、科学的参考依据。方法 通过文献查阅、筛查与评价, 提取可行性资料, 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系的框架, 并采用德尔菲法完成两轮专家函询,确定最终的指标体系。选择2021年1月—2024年1月本院收治的230例急诊脑出血患者为研究对象, 将2021年1月—2022年6月作为干预前监测节点,该阶段的165例患者为传统组, 实施常规的护理质量管理;将2022年7月—2024年1月作为干预后监测节点,该阶段的165例患者为观察组, 实施以急诊脑出血患者护理质量评价指标进行护理质量监测管理。结果 两轮函询中专家积极系数分别为95%和100%, 意见提出率分别为56.25%和35.54%; 两轮函询专家权威系数为0.945、0.893; 第1轮函询中各项指标变异系数（CV）均值为0~0.136, Kendall’s W协调系数为0.065; 第2轮函询中变异系数（CV）均值为0~0.110, Kendall’s W协调系数为0.186。最终形成的急诊脑出血患者护理质量评价体系共涵盖一级指标3个、二级指标11个、三级指标55个。观察组入院-用药时间合格率、吞咽障碍患者动态评估率、气道管理合格率、早期被动/主动活动落实率高于传统组,差异具有统计学意义（χ²=14.850、12.261、8.183、37.420, P<0.05）, 观察组患者满意度明显高于传统组（χ²=14.049, P<0.001）。结论 本研究构建的急诊脑出血患者护理质量评价体系具有一定的科学性、可靠性和实用性, 可作为临床实现护理质量持续改进的重要评价工具。

Objective Based on the Donabedian model,the nursing quality evaluation system of emergency cerebral hemorrhage patients was constructed, and applied to clinical practice, providing an objective and scientific reference basis for realizing the nursing quality management, monitoring and evaluation of emergency cerebral hemorrhage patients．Methods Through literature review, screening and evaluation, the feasibility data was extracted, and the framework of the nursing quality evaluation system for patients with emergency cerebral hemorrhage was constructed based on the Donabedian model, and the Delphi method was adopted to complete two rounds of expert letter inquiry to determine the final index system．The study selected 230 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2024 as the research subjects．The period from January 2021 to June 2022 was used as the pre-intervention monitoring period, during which 165 patients were in the traditional group, receiving routine nursing quality management．The period from July 2022 to January 2024 was used as the post-intervention monitoring period, during which 165 patients were in the observation group,implementing nursing quality monitoring and management based on evaluation indicators for the care of patients with acute cerebral hemorrhage．Results In the two rounds of letter inquiry, the positive coefficient of experts was 95% and 100%, respectively, and the rate of suggestions was 56.25% and 35.54%, respectively; the authority coefficient of experts in the two rounds of letter inquiry was 0.945 and 0.893．In the first round the mean value of coefficient of variation（CV）of each index was 0~0.136, and the coordination coefficient of Kendall’s W was 0.065; in the second round the mean value of variation coefficient（CV）was 0-0.110, and the coordination coefficient of Kendall's W was 0.186．The final nursing quality evaluation system for emergency cerebral hemorrhage patients covers 11 first-level indicators, 11 second-level indicators and 55 third-level indicators．The results showed that the pass rate of admission-medication time, dynamic assessment rate of dysphagia patients, airway management rate, and early passive / active activity implementation rate of the observation group were statistically significant different from those in the traditional group（χ²=14.850,12.261, 8.183, 37.420, P<0.05）, and the patient satisfaction in the observation group was significantly higher than that in the traditional group（χ²=14.049, P<0.001）．Conclusions The nursing quality evaluation system for emergency cerebral hemorrhage patients constructed in this study is scientific,reliable and practical, and can be used as an important evaluation tool to achieve continuous improvement of nursing quality in clinical practice．

自发性脑出血由于外伤性原因引起脑实质出血作为神经系统急危重症,该患病率约占所有脑卒中的10%~15%, 具有高患病率、高死亡率、高致残率的特点, 随着年龄的不断增长血管逐渐变薄、失去弹性,受到外在原因干扰时, 导致出血, 形成血肿, 依据血肿的不同程度, 患者的生存及预后有着显著的差异。因此快速且及时识别自发性脑出血尤为重要,可为临床医生评估患者病情变化及预后具有重要指导的意义, 然而在临床实践过程中对于快速识别脑出血的方法有所欠缺, 需要进一步优化其监测方法。因此本文综述了自发性脑出血的监测方法, 探讨通过无创监测、有创监测及联合监测自发性脑出血为临床快速高效判断脑出血提供科学的依据和参考。

The incidence of spontaneous cerebral hemorrhage accounts for about 10% to 15% of the stroke cases, and it has the characteristics of high incidence, high mortality rate, and high disability rate．It is very important to quickly identify spontaneous cerebral hemorrhage, which has important guiding significance for clinical doctors to evaluate patient condition changes and prognosis．This article reviews the latest research on non-invasive monitoring, invasive monitoring, and combined monitoring of spontaneous cerebral hemorrhage.

目的 了解脑出血患者家属参与治疗共享决策满意度现状及其影响因素,为提升脑出血患者的护理质量和家属体验提供参考。方法 采用横断面研究设计,便利抽取2022年1月—2023年7月许昌中医院收治的脑出血患者及其家属进行问卷调查。结果 共回收问卷178份,全部纳入分析。患者家属参与医疗决策的满意度得分为（48.58±6.34）分,其中维度得分最低的为交流协商。多因素分析结果显示,家属教育程度、家属年龄、家庭总年收入以及患者家属对医疗决策知情程度为患者家属参与医疗决策满意度的影响因素（F=30.872,P<0.001）,解释40.3%的变异。结论 脑出血患者家属参与治疗共享决策满意度处于中等水平,患者家属对医疗决策知情程度越高、家属教育程度越高、家属年龄较大以及家庭总年收入越高的脑出血患者家属参与治疗共享决策满意度越高。

自发性脑出血（SICH）是脑卒中的一种常见形式,其预后通常较差,因此早期评估和调节患者出血后的免疫状态至关重要。免疫检查点是评估T淋巴细胞活跃性和增殖状态的关键指标,监测这些检查点有助于预测脑出血患者的预后。程序性死亡蛋白1（PD-1）和细胞分化抗原28（CD28）作为两个典型的免疫检查点,它们在脑出血预后评估中的应用正逐渐成为研究的热点。该文综述了脑出血后机体免疫状态的变化,以及PD-1和CD28在脑出血后评估和治疗中的研究进展。

Spontaneous intracerebral hemorrhage（SICH）is a common cause of stroke,with specific outcomes often being poor．Therefore,early assessment and modulation of the immune status after hemorrhage are of critical importance．Immune checkpoints serve as key indicators for assessing the activation and proliferation of T cells,and monitoring these checkpoints can help to predict the outcomes of patients with intracerebral hemorrhage．PD-1（programmed death 1）and CD28（Cluster of Differentiation 28）are two representative immune checkpoints,and their use in prognostic assessment after intracerebral hemorrhage is becoming a focus of research．This article reviews the changes in the immune state of the body after intracerebral hemorrhage,as well as the research progress on the use of PD-1 and CD28 in the evaluation and treatment following intracerebral hemorrhage．

目的 探讨系统化护理流程干预对脑出血患者急救效果及预后的影响。方法 采用回顾性分析的方法,选取2022年2月—2023年2月新乡医学院第三附属医院急诊收治的210例脑出血患者,将2022年2月—2022年8月采取常规护理干预的105例患者作为常规组,将2022年9月—2023年2月采取系统化护理流程干预的105例患者作为研究组。对比两组患者抢救效率、急救效果、并发症发生率、预后水平、护理满意度情况。结果 研究组患者抢救总时间、会诊至确诊、分诊至会诊、接诊至分诊以及出诊反应时间短于常规组（P<0.05）;研究组急救总有效率高于常规组,并发症发生率低于常规组（P<0.05）;出院1个月、3个月后,两组患者神经功能缺损量表（NIHSS）评分均降低,简易智能状态检查量表（MMSE）评分升高,研究组变化幅度更大（P<0.05）;研究组患者护理满意度高于常规组（P<0.05）。结论 针对脑出血患者在急救过程中采取系统化护理流程干预能够提升患者的抢救效率和急救效果,并发症发生率低,改善患者的神经功能缺损情况,提升预后水平,且患者满意度较高。

Objective To explore the impact of systematic nursing process intervention on the emergency response and prognosis of patients with cerebral hemorrhage．Methods By retrospective analysis,210 patients with cerebral hemorrhage admitted to the emergency department of the Third Affiliated Hospital of Xinxiang Medical College from February 2022 to February 2023,105 patients with routine nursing intervention from February 2022 to August 2022 were selected as the routine group,and 105 patients with systematic nursing process intervention from September 2022 to February 2023 were selected as the study group．The rescue efficiency,first aid effect,complication rate,prognosis levels and nursing satisfaction of the two groups were compared．Results The total rescue time,consultation to diagnosis,triage to consultation,reception to triage and the response time to visit in the study group were significantly lower（P<0.05）．The total emergency response rate of the study group was higher than that of the conventional group,and the incidence of complications was significantly lower（P<0.05）．One month and 3 months after discharge,NIHSS score decreased in both groups,MMSE score increased,and the change range was greater in the study group（P<0.05）．The nursing satisfaction of the study group was significantly higher（P<0.05）．Conclusions For patients with cerebral hemorrhage,systematic nursing process intervention in the first aid process can improve the rescue efficiency and first aid effect of patients,reduce the incidence of complications,improve the neurological function defect of patients,improve the prognosis level,and the patient satisfaction is higher．

目的 分析医院急诊患者24小时诊疗数据与临床路径标准的差异,以此探讨现行诊疗路径存在的问题及提升策略。方法 统计和分析本院2021年1月—2021年12月间收治的218例急性消化道出血和82例急性脑出血患者急诊治疗相关诊疗数据,并与相关疾病诊疗指南进行对比,分析实际诊疗数据与临床路径标准的差异,探究问题出现的原因并探讨针对性改良方案。结果 急性消化道出血临床路径诊疗标准规定检查项目为13项,急性消化道出血患者的应用率为100%,其中有11项符合率>50%,占比84.62%;急性脑出血临床路径诊疗标准规定检查项目为14项,急性脑出血患者的应用率为100%,其中有10项符合率>50%,占比71.43%;急性消化道出血患者中,超出临床路径检查标准项目9项,且检查率均在50%以上;急性脑出血患者中,超出临床路径检查标准项目4项,其中2项检查率在50%以上;在治疗措施方面,急性消化道出血、急性脑出血的实际治疗与临床路径标准基本相符,在针对不同病情时会采用不同治疗方法,会存在一定差异。结论 医院临床实际疾病诊疗情况与临床路径诊疗标准间尚存在一定差异,医院必须对问题进行分析,不断优化诊疗路径,进一步提升临床路径实用性、可行性、规范性以及科学性,为居民提供更优质的医疗服务,同时减轻患者医疗经济负担。

目的 探讨CT混合征和岛征及其联合征象对脑出血早期血肿扩大的临床预测价值。方法 将2018年12月—2020年12月河南宏力医院收治的脑出血患者86例作为研究对象,按照有无血肿扩大分为早期血肿扩大组(38例)和血肿未扩大组(48例)。分析CT平扫的岛征、混合征及联合征象对早期血肿扩大的影响,使用ROC曲线及曲线下面积(area under the curve,AUC)比较混合征、岛征及联合征对脑出血后血肿扩大的诊断效能。结果 混合征、岛征、联合征象诊断血肿扩大的灵敏度分别为65.79%、50.00%、84.21%,特异度分别为72.92%、83.33%、93.75%,阳性预测值分别为65.79%、70.37%、91.43%,阴性预测值分别为72.92%、67.80%、88.24%。不同影像学征象诊断血肿扩大的灵敏度、特异度、阳性预测值和阴性预测值差异均具有统计学意义(P<0.05)。ROC曲线分析中,混合征、岛征、联合征象诊断血肿扩大的AUC分别为0.690、0.656和0.811,P均小于0.05,其中联合征象的AUC最大。结论 CT征象中的混合征和岛征分别对脑出血早期血肿扩大的患者进行有效的预测,但相较于单独征象而言,二者的联合征象的诊断效能更高,对患者早期是否出现血肿扩大的现象诊断效能更具有科学性、高效性,为临床后期的治疗提供指导意义,同时也对患者疾病的恢复及预后起到积极作用。