建立预测法洛四联症根治术后出血风险的列线图  

Development of nomogram predicting postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot

作　　者：沈瑞环 王旭[1] 鲁中原[1] 李守军[1] 闫军[1] SHEN Ruihuan;WANG Xu;LU Zhongyuan;LI Shoujun;YAN Jun(Department of Pediatric Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院小儿心脏中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2021年第4期409-415,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：中国医学科学院临床与转化基金(2019XK320053);国家重点研发计划资助项目(2017YFC1308100)。

摘　　要：目的明确儿童法洛四联症(tetralogy of Fallot,TOF)根治术后出血的危险因素并构建具有预测术后出血风险性能的列线图。方法回顾性分析2018年11月至2019年6月在我院行TOF根治手术儿童的临床数据。术后出血定义为术后24 h内的胸腔积液量≥16 mL/kg,相当于本研究人群的第75个百分位数。主要结果采用最小绝对收缩与选择算子(the least absolute shrinkage and selection operator,LASSO)回归、单因素以及多因素logistic回归分析确定术后出血的独立预测因素,在此基础上构建列线图,并分析其一致性、区分度。结果入选儿童105例。出血组术后24 h胸腔积液量明显高于非出血组(P<0.0001)。多因素logistic回归分析显示,患儿低体重[odds ratio(OR)=0.538,95%confidence interval(CI)0.369~0.787,P=0.001]、术前高血红蛋白浓度(OR=1.036,95%CI 1.008~1.066,P=0.013)、术中主动脉阻断时间长(OR=1.022,95%CI 1.000~1.044,P=0.048)是术后出血风险独立预测因素。在内部验证中,列线图C-指数为0.835(95%CI 0.745~0.926),并且其校准曲线质量高。结论本研究建立的列线图在评估TOF根治术后出血风险方面显示出良好的一致性与区分度。Objective To identify the risk factors of postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot(TOF)and to develop nomogram predicting the risk of postoperative blood loss.Methods A retrospective case-control study was conducted in pediatric TOF patients who underwent corrective operation in our hospital from November 2018 to June 2019.And the clinical data from each enrolled patient were gathered and analyzed.Clinically significant postoperative blood loss was defined as drainage volume from chest tube≥16 mL/kg during the first 24 h after surgery,which corresponded to the 75th percentile of the blood loss in our population.The primary outcome was to determine the independent predictors of postoperative blood loss by the least absolute shrinkage and selection operator(LASSO)regression,univariate and multivariate logistic regression analysis.On the basis of the independent predictors of postoperative bleeding,nomogram was developed and its discrimination and calibration were estimated.Results A total of 105 children were selected(67 males and 38 females aged 3-72 months).The drainage volume from chest tube in the bleeding group was significantly higher than that in the non-bleeding group during the first 24 h(P<0.0001).Multivariate logistic regression analysis showed that low body weight(OR=0.538,95%CI 0.369-0.787,P=0.001),high preoperative hemoglobin concentration(OR=1.036,95%CI 1.008-1.066,P=0.013)and prolonged intraoperative aortic cross clamp time(OR=1.022,95%CI 1.000-1.044,P=0.048)were independent risk factors for postoperative blood loss.In the internal validation,the model displayed good discrimination with a C-index of 0.835(95%CI 0.745-0.926)and high quality of calibration plots in nomogram models was noticed.Conclusion The nomogram demonstrated good discrimination and calibration in estimating the risk of postoperative blood loss among pediatric patients following corrective operation of TOF.

关 键 词：列线图 法洛四联症 紫绀 术后出血 危险因素 

分 类 号：R726.5[医药卫生—儿科]