摘要
目的探讨经鼻蝶垂体瘤切除术患者发生迟发性低钠血症(DH)的危险因素,构建列线图模型,并验证该模型的预测效果,从而科学指导后续的治疗和护理。方法便利抽样法选取河南省人民医院、安阳市人民医院、周口市中心医院2020年6月至2023年1月行经鼻蝶垂体瘤切除术的768例患者为研究对象,将患者按7∶3的比例分为建模组(537例)和验证组(231例),通过对建模组进行单因素和多因素Logistic回归分析探索DH发生的独立危险因素,建立风险预测模型并绘制列线图,采用模型校准曲线和ROC曲线下面积验证模型预测效果,并通过验证组对模型进行外部验证。结果建模组537例经鼻蝶垂体瘤切除术患者,男290例(54.0%),年龄21~79(50.12±14.54)岁;二项Logistic回归分析显示,年龄>55岁(OR=1.904)、手术时长≥2 h(OR=3.413)、垂体功能低下(OR=2.801)、存在术前肿瘤侵袭(OR=1.726)以及术后1~2 d最低血钠浓度<135 mmol/L(OR=3.198)是患者发生DH的危险因素(均P<0.05)。基于以上因素建立列线图预测模型,建模组ROC曲线下面积为0.769,95%CI为0.731~0.804,最佳临界值为≥0.132,灵敏度为81.75%,特异度为59.12%;验证组ROC曲线下面积为0.847,95%CI为0.794~0.891,灵敏度为76.00%,特异度为76.80%,模型预测正确率为71.43%。结论本研究构建的风险预测模型效果良好,可为临床评估经鼻蝶垂体瘤切除术患者是否存在DH风险提供借鉴。
Objective To explore the risk factors of delayed hyponatremia(DH)in patients undergoing transsphenoidal pituitary adenoma resection,construct a column chart model,and verify the predictive effect of the model,in order to scientifically guide subsequent treatment and nursing.Methods Convenient sampling method was used to select 768 patients who underwent transnasal transsphenoidal pituitary adenoma resection in Henan Provincial People′s Hospital,Anyang City People′s Hospital and Zhoukou Central Hospital from June 2020 to January 2023 as the research subjects.The patients were divided into a modeling group(537 cases)and a validation group(231 cases)in a 7∶3 ratio.Single factor and multiple factor logistic regression analysis was conducted on the modeling group to explore independent risk factors for the occurrence of DH,and a risk prediction model was established and a column chart was drawn,Use the model calibration curve and the area under the ROC curve to verify the predictive effect of the model,and conduct external validation of the model through the validation group.Results The modeling group consisted of 537 patients who underwent transsphenoidal pituitary tumor resection,including 290 males(54.0%)aged 21-79(50.12±14.54)years old;binomial logistic regression analysis showed that age>55 years old(OR=1.904),surgical duration≥2 hours(OR=3.413),pituitary dysfunction(OR=2.801),presence of preoperative tumor invasion(OR=1.726),and postoperative minimum blood sodium concentration<135mmol/L(OR=3.198)were risk factors for developing DH in patients(all P<0.05).Based on the above factors,a column chart prediction model was established.The area under the ROC curve of the modeling group was 0.769,with a 95%CI of 0.731-0.804.The optimal critical value was≥0.132,sensitivity was 81.75%,and specificity was 59.12%;the area under the ROC curve of the validation group was 0.847,with a 95%CI of 0.794-0.891,a sensitivity of 76.00%,a specificity of 76.80%,and a model prediction accuracy of 71.43%.Conclusions The predict
作者
许健
张驰
周东阳
张海鑫
李蕊
冯英璞
Xu Jian;Zhang Chi;Zhou Dongyang;Zhang Haixin;Li Rui;Feng Yingpu(Neurosurgery Department,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Nursing Department,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Neurosurgery Department,Zhoukou Central Hospital,Zhoukou 466099,China;Henan Provincial Key Laboratory of Nursing Medicine,Zhengzhou 450003,China)
出处
《中国实用护理杂志》
2024年第12期947-953,共7页
Chinese Journal of Practical Nursing
基金
2021年度河南省医学科技攻关计划联合共建项目(LHGJ20210021)。
关键词
列线图
经鼻蝶垂体瘤切除术
迟发性低钠血症
垂体腺瘤
预测模型
Nomograms
Transsphenoidal pituitary surgery
Delayed hyponatremia
Pituitary adenoma
Prediction model
