急性缺血性脑卒中病人吞咽障碍风险预测模型的构建与验证

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Construction and validation of a risk prediction model for dysphagia in patients with acute ischemic stroke

GONG Siyuan，TANG Rongzhu，HU Wangjuan，WANG Tianqi，LI Jia，LIAO Chunlian，LIU JihongThe Second Affiliated Hospital of Chongqing Medical University，Chongqing 400000 ChinaCorresponding Author LIU Jihong，E-mail：ljhcq@cqmu.edu.cn

Abstract Objective：To explore the risk factors for dysphagia in patients with acute ischemic stroke（AIS），to construct a nomogram risk prediction model，and to conduct validation.Methods：A total of 644 AIS patients hospitalized in the Department of Neurology of a tertiary Grade A hospital in Chongqing from February 2023 to October 2023 were selected by convenience sampling and divided into a modeling set（n=448）and a validation set（n=196）.Logistic regression analysis was used to establish a prediction model and draw a nomogram.The Bootstrap method was used for internal validation，and the validation set was used for external validation.The area under the receiver operating characteristic curve（ROC），Hosmer-Lemeshow test，C-index，calibration curve，and clinical decision curve were used to evaluate the predictive value of the model.Results：Age≥60 years，NIHSS score≥7 points，brainstem infarction，multiple lesions，and the worst limb muscle strength≤3 were independent influencing factors for dysphagia in AIS patients.The validation results of the nomogram model showed that the area under curve（AUC）of the modeling set and the validation set were 0.83 and 0.80，respectively;the C-index was 0.82 and 0.78，respectively;the Hosmer-Lemeshow goodness of fit test was χ2=5.05，P=0.65;χ2=12.30，P=0.14，respectively;the two calibration curves were basically consistent and the slope was close to 1;the decision curve results showed that when the threshold probability range was 0.00-0.89，the clinical net benefit was greater.Conclusions：The nomogram model constructed in this study has good predictive ability which could provide a basis for the early identification and management of AIS patients with dysphagia.

Keywords acute ischemic stroke;dysphagia;influencing factors;nomogram;prediction model;nursing

摘要 目的：探讨急性缺血性脑卒中（AIS）病人发生吞咽障碍的危险因素，构建列线图风险预测模型并进行验证。（剩余9274字）