老年患者髋关节置换术后并发症预测模型的建立与分析  

Establishment and analysis of predictive models of postoperative complications in elderly patients undergoing hip arthroplasty

作　　者：王梦诗[1] Wang Mengshi(Department of Orthopedic, People′s Hospital of Wanning, Hainan 571500, China)

机构地区：[1]海南省万宁市人民医院骨科,571500

出　　处：《中国实用护理杂志》2019年第20期1545-1550,共6页Chinese Journal of Practical Nursing

摘　　要：目的通过分析老年患者髋关节置换术后并发症的危险因素,建立列线图评价模型,并评价预测术后并发症的准确性,为分级护理提供依据。方法选择2012年1月至2018年8月海南省万宁市人民医院骨科收治的老年髋关节置换术患者148例为研究对象,其中发生术后并发症的患者23例作为并发症组,125例无并发症的患者作为对照组。单因素分析发生并发症的相关因素,将有统计学意义的指标纳入多因素Logistic回归模型,分析老年患者髋关节置换术后并发症的危险因素。根据回归分析结果,建立列线图评价模型。利用ROC曲线及Hosmer-Lemeshow检验评价模型预测效能。结果多因素分析显示,年龄(OR=1.239,95%CI1.002~1.531,P=0.048)、血糖(OR=2.961,95%CI 1.055~8.311,P=0.039)、手术大小(OR=4.997,95%CI 1.269~19.686,P=0.021)是发生术后并发症的危险因素,白蛋白(OR=0.696,95%CI 0.535~0.904,P=0.007)是发生术后并发症的保护因素。ROC曲线显示列线图模型预测老年患者髋关节置换术后并发症曲线下面积(AUC)0.988(95%CI0.975~1.000),特异性为96.77%,敏感性为99.82%。结论基于年龄、血糖、白蛋白、手术大小建立预测老年患者髋关节置换术后并发症发生风险的列线图模型,具有良好的特异性和敏感性,临床价值较高。Objective To establish a preoperative evaluation model and evaluate the accuracy of postoperative complications by analyzing the risk factors of postoperative complications in hip arthroplasty in elderly patients, and to provide a basis for grading nursing. Methods From January 2012 to August 2018, 148 patients with elderly patients undergoing hip arthroplasty admitted to People′s hospital of Wanning were included in the study. Among them, 23 patients with postoperative complications were included as complications and 125 patients without complications served as a control group. Univariate analysis of the factors associated with complications, statistically significant indicators were included in the multivariate logistic regression model, and the risk factors for postoperative complications in hip arthroplasty were analyzed. Based on the results of the regression analysis, a preoperative evaluation model was established. The ROC curve and the Hosmer-Lemeshow test were used to evaluate the model prediction performance. Results Multivariate analysis showed age (OR=1.239, 95%CI: 1.002-1.531, P=0.048), Glu (OR=2.961, 95%CI: 1.055-8.311, P=0.039), surgical size (OR=4.997, 95%CI: 1.269-19.686, P=0.021) were risk factors for postoperative complications, Albumin (OR=0.696, 95%CI: 0.535-0.904, P=0.007) was a protective factor for postoperative complications (P<0.05). The ROC curve showed a nomogram model predicting the area under the complication curve (AUC) of 0.988 (95%CI:0.975-1.000), with a specificity of 96.77% and a sensitivity of 99.82%. Conclusion A nomogram model based on age, Glu, albumin, surgery size to predict the risk of complications after hip arthroplasty in elderly patients has a good specificity and sensitivity, high clinical value.

关 键 词：老年人 关节成形术 置换 髋 术后并发症 危险因素 列线图模型 

分 类 号：R473.6[医药卫生—护理学]