个体化预测早期消化道肿瘤ESD术后迟发性出血风险的列线图模型的建立  

Establishment of a Nomogram model for individualized prediction of the risk of delayed bleeding after endoscopic submucosal dissection for early gastrointestinal tumors

作　　者：杨桂凤[1] 虞敏亚[2] 杨雪兰[1] Yang Guifeng;Yu Minya;Yang Xuelan(Department of Gastroenterology,Jiangsu Taizhou People's Hospital,Jiangsu Province,Taizhou 225300,China;Department of Gastroenterology,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]江苏省泰州市人民医院消化内科,225300 [2]江苏省人民医院消化内科,南京210029

出　　处：《中华现代护理杂志》2021年第2期164-170,共7页Chinese Journal of Modern Nursing

摘　　要：目的探讨个体化预测早期消化道肿瘤患者内镜黏膜下剥离术(ESD)术后迟发性出血的风险因素,建立列线图模型,并提出护理对策。方法回顾性分析2017年12月—2019年12月因早期消化道肿瘤于泰州市人民医院行ESD治疗的236例患者资料,分别使用单因素和二分类Logistic回归分析术后发生迟发性出血的独立危险因素并建立列线图预测模型。结果长期使用抗血栓药物(OR=4.990)、活检次数≥3次(OR=7.834)、伴溃疡和瘢痕(OR=6.079)、病变直径≥3 cm(OR=5.316)、浸润至黏膜下层(OR=5.667)、术中明显出血(OR=5.745)及术者经验(OR=7.660)是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素(P<0.05)。基于以上7项独立危险因素建立相关列线图预测模型,并对该模型进行验证,H-L偏差度检验结果为χ^(2)=3.753,P=0.663,C-index为0.907(95%置信区间0.877~0.937),说明列线图预测模型具有良好的精准度和区分度。结论长期使用抗血栓药物、活检次数≥3次、伴溃疡和瘢痕、病变直径≥3 cm、浸润至黏膜下层、术中明显出血及手术者不熟练是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素,建立的列线图模型具有准确的预测能力和区分度,有利于护理人员筛查高风险患者并制订相关护理对策。Objective To explore risk factors of individually predicting delayed bleeding after endoscopic submucosal dissection(ESD)for patients with early gastrointestinal tumors,to establish Nomogram model and to propose nursing countermeasures.Methods Data of 236 patients who received ESD in Jiangsu Taizhou People's Hospital due to early gastrointestinal tumor from December 2017 to December 2019 were retrospectively analyzed.The independent risk factors for postoperative delayed bleeding were analyzed by univariate Logistic regression and binary Logistic regression respectively and a Nomogram prediction model was established.Results Long-term use of antithrombotic drugs(OR=4.990),the number of biopsies greater or equal to 3(OR=7.834),accompanied by ulcers and scars(OR=6.079),lesion diameter greater or equal to 3 cm(OR=5.316),infiltration to submucosa(OR=5.667),intraoperative marked bleeding(OR=5.745)and experience of surgeons(OR=7.660)were independent risk factors for delayed bleeding after ESD in early gastrointestinal tumors(P<0.05).A related Nomogram prediction model was established based on the above 7 independent risk factors,and the model was verified.The H-L deviation test result wasχ^(2)=3.753,P=0.663 and C-index was 0.907(95%CI 0.877-0.937),which indicated Nomogram prediction model had good accuracy and dipartite degree.Conclusions Long-term use of antithrombotic drugs,the number of biopsies greater or equal to 3,accompanied by ulcers and scars,lesion diameter greater or equal to 3 cm,infiltration to submucosa,intraoperative marked bleeding and unskilled surgeons are independent risk factors for delayed bleeding after ESD in early gastrointestinal tumors.Nomogram model established has accurate predictive ability and dipartite degree,which is helpful for nursing staff to screen high-risk patients and formulate relevant nursing strategies.

关 键 词：消化系统肿瘤 列线图 内镜黏膜下剥离术 迟发性出血 护理对策 

分 类 号：R473.73[医药卫生—护理学]