妇科阴式手术后尿潴留影响因素分析及预测模型构建  

Analysis of influencing factors and predictive model construction of urinary retention after gynecological vaginal surgery

作　　者：夏秀芳[1] 张静[1] 苏高莉[1] 梁丽盈 吴杰杰 XIA Xiufang;ZHANG Jing;SU Gaoli;LIANG Liying;WU Jiejie(Department of Gynecology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530021,P.R.China)

机构地区：[1]广西壮族自治区人民医院妇科,广西南宁530021

出　　处：《中国计划生育和妇产科》2021年第6期85-88,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(项目编号:Z2015680);广西壮族自治区卫生健康委员会自筹课题(项目编号:Z20180754)。

摘　　要：目的探讨妇科阴式手术后尿潴留的影响因素及构建相关预测模型。方法选取2016年1月至2019年12月在广西壮族自治区人民医院接受妇科阴式手术治疗的458例患者为研究对象,根据患者是否发生尿潴留分为尿潴留组(23例)和无尿潴留组(435例)。收集患者的年龄、体质量指数、高血压、糖尿病、剖宫产史、围手术期使用药物(包括抗胆碱能药物、拟交感神经药物)、术中出血量、手术时间、导尿管留置时间及术前血清C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)水平等资料,对妇科阴式手术后尿潴留的影响因素先行单因素筛选,再行Logistic多因素回归分析并建立相应预测模型,应用ROC曲线检测其区分度,应用拟合优度检验评价其校准度。最后通过选取2020年1月至2020年6月的105例行妇科阴式手术患者对预测模型进行临床验证。结果剖宫产史、围手术期使用药物(抗胆碱能药物、拟交感神经药物)患者在尿潴留组中的比例显著高于无尿潴留组,尿潴留组患者术前血清CRP、IL-6水平显著高于无尿潴留组,差异均有统计学意义(P<0.05)。Logistic多因素回归分析结果显示,剖宫产史、围手术期使用药物(抗胆碱能药物、拟交感神经药物)及血清CRP、IL-6水平均是妇科阴式手术后尿潴留的影响因素(P<0.05)。构建相关因素预测模型(Logit模型)为:Logit(P)=1.590×剖宫产史+1.836×围手术期使用药物+1.756×CRP-2+1.823×(IL-6)-6.985,预测模型曲线下面积为0.865,该模型的阈值为0.071(灵敏度为0.826,特异度为0.821);Hosmer-Lemeshowχ^(2)=6.012,P=0.646。结论剖宫产史、围手术期使用药物(抗胆碱能药物、拟交感神经药物)及术前血清CRP、IL-6水平是妇科阴式手术后尿潴留的影响因素,据此建立的预测模型区分能力良好,校准度高,具有较高的预测价值。Objective To explore the influencing factors of urinary retention after gynecological vaginal surgery and construct related predictive models.Methods A total of 458 patients who underwent gynecological vaginal surgery at the People’s Hospital of Guangxi Zhuang Autonomous Region from January 2016 to December 2019 were selected as the research objects.According to whether the patients had urinary retention,they were divided into urinary retention group(23 cases)and non-urinary retention group(435 cases).Collected the patients’age,body mass index,hypertension,diabetes,history of cesarean section,perioperative medications(including anticholinergic drugs,sympathomimetic drugs),intraoperative bleeding,operation time,and catheter indwelling time and preoperative serum CRP,IL-6 levels and other data.The influencing factors of urinary retention after gynecological vaginal surgery were screened first,and then Logistic multi-factor regression analysis was performed and the corresponding prediction model was established.The ROC curve was used to detect its discrimination.The goodness of fit test was used to evaluate the degree of calibration.Finally,the prediction model was clinically verified by selecting 105 patients who underwent gynecological vaginal surgery from January 2020 to June 2020.Results The proportion of patients with a history of cesarean section and perioperative medications(anticholinergic drugs,sympathomimetic drugs)in the urinary retention group was significantly higher than that in the non-urinary retention group.The preoperative serum CRP and IL-6 levels of patients in the urinary retention group were significantly higher than that of the non-urinary retention group,and the differences were statistically significant(P<0.05).Logistic multivariate regression analysis showed that the history of cesarean section,perioperative drugs(anticholinergic drugs,sympathomimetic drugs)and serum CRP and IL-6 levels were the influencing factors of urinary retention after gynecological vaginal surgery(P<0.05).The pre

关 键 词：妇科阴式手术 尿潴留 影响因素 预测模型 

分 类 号：R713.3[医药卫生—妇产科学]