摘要
目的探讨真实世界全身麻醉下后入路腰椎融合术(posterior lumbar interbody fusion,PLIF)术后胃肠道功能障碍(postoperative gastrointestinal dysfunction,POGD)的影响因素并构建预测模型。方法选择2019年12月至2021年9月中国中医科学院望京医院接受PLIF手术的363例患者,通过单因素分析及多因素logistic回归分析,筛选出POGD的独立危险因素,纳入并建立Nomogram预测模型。计算相对校正的C指数验证模型的区分度,采用绘制Calibration校准曲线验证模型的一致性,采用决策曲线分析(decision curve analysis,DCA)验证Nomogram预测模型的临床预测效能。结果363例PLIF患者中,POGD组108例(29.8%),非POGD组255例(70.2%)。经单因素分析及多因素logistic回归分析最终筛选出6个危险因素,即吸烟史、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级≥Ⅱ级、合并心脏疾病、肝胆疾病、胃肠疾病、血管疾病。纳入并建立Nomogram预测模型。经内部验证,该模型C指数为0.768,具有较好的区分度;校准曲线显示一致性良好。DCA曲线表明当POGD发生风险阈值在10.0%~72.0%时,此列线图具有临床使用价值。结论基于真实世界的Nomogram预测模型对PLIF患者发生POGD风险有良好的预测性能。
Objective To investigate the postoperative gastrointestinal dysfunctiort(POGD)of posterior lumbar interbody fusion(PLIF)under real world general anesthesia and build a prediction model.Methods A total of 363 PLIF patients from December 2019 to September 2021 were enrolled in the study.Independent risk factors were identified by univariate analysis and multivariate logistic regression analysis.A Nomogram prediction model was established.Con-cordance index(C-index)and calibration curve were used to verify the differentiation and consistency of the model,and decision curve analysis(DCA)was used to verify the clinical prediction efficiency of the model.Results There were 363 PLIF patients in the study,108 cases(29.8%)were in POGD group and 255 cases(70.2%)were in non-POGD group.Six risk factors were screened out,which were smoking history,American Society of Anesthesiologists(ASA)grade≥Ⅱ,complicated with heart disease,hepatobiliary disease,gastrointestinal disease,vascular disease.After internal verification,the C-index of this model was 0.768,which had a good degree of differentiation.The calibration curves showed a good consistency.The DCA curve showed that when the risk threshold of POGD was 10.0%-72.0%,the line map had clinical value.Conclusions This Nomogram prediction model based on the real world has good performance in predicting the risk of POGD in PLIF patients.
作者
张鑫微
张志军
贾若
张世民
徐惠青
Zhang Xinwei;Zhang Zhijun;Jia Ruo;Zhang Shimin;Xu Huiqing(Department of Anesthesiology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing100102,China)
出处
《北京医学》
CAS
2022年第4期292-297,共6页
Beijing Medical Journal
基金
中国中医科学院院内联合创新专项(ZZ11-033)。
关键词
术后胃肠功能障碍
后入路腰椎融合术
真实世界
影响因素
Nomogram预测模型
postoperative gastrointestinal dysfunctiort(POGD)
posterior lumbar interbody fusion(PLIF)
real-word study
influencing factor
Nomogram prediction model
