儿童院内心脏骤停预后预测模型的建立及评价  

Establishment and evaluation of prognostic prediction model of in-hospital cardiac arrest in children

作　　者：李旭锋 郭予雄 叶晓婷 陈纯玲 郑贵浪 孙跃玉 温树生[3] 王树水[4] 罗丹东[3] LI Xu-feng;GUO Yu-xiong;YE Xiao-ting;CHEN Chun-ling;ZHENG Gui-lang;SUN Yue-yu;WEN Shu-sheng;WANG Shu-shui;LUO Dan-dong(Guangdong Cardiovascular Institute,Guangzhou 510100,China;Pediatric Intensive Care Unit,Guang-dong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Section of Pediatric Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospi-tal,Guangdong Academy of Medical Sciences,Guangzhou 510100,China;Department of Pediatric Cardiolo-gy,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medi-cal Sciences,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所,广州510100 [2]广东省人民医院(广东省医学科学院)儿科重症监护室,广州510080 [3]广东省心血管病研究所小儿心脏外科广东省人民医院(广东省医学科学院),广州510100 [4]广东省心血管病研究所心儿科广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2022年第2期139-143,164,共6页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划项目(项目编号:2020YFC1107904)。

摘　　要：目的 分析住院儿童发生心脏骤停预后的相关危险因素,构建并评价预测儿童院内心脏骤停预后的列线图模型。方法 纳入2009年1月至2020年12月广东省人民医院发生院内心脏骤停患儿,根据出院结局分为存活组和死亡组,比较两组患儿的相关临床资料,采用多因素Logistic回归分析儿童院内心脏骤停预后的独立危险因素,应用R软件构建预测儿童院内心脏骤停预后的列线图模型,采用Bootstrap法进行模型内部验证,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)、校正曲线评估模型效能。结果 75例患儿中存活29例(38.7%),死亡46例(61.3%)。单因素分析结果显示,两组患儿年龄、合并心力衰竭、肝功能不全、儿童序贯器官衰竭评分(pediatric sequential organ failure assessment,p SOFA)、血管活性药物评分(vasoactive-inotropic score,VIS)、心肺复苏持续时间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,pSOFA(OR=1.268,95%CI:1.005~1.601)、心肺复苏持续时间10~30 min(OR=8.032,95%CI:1.487~43.378)、心肺复苏持续时间>30 min(OR=46.263,95%CI:7.588~282.074)是儿童院内心脏骤停死亡的独立危险因素(P<0.05)。基于影响儿童院内心脏骤停预后的独立危险因素建立列线图模型,列线图模型的ROC曲线下面积为0.881(95%CI:0.803~0.959),内部验证得到校正曲线趋近于理想曲线,Hosmer-Lemeshow拟合优度检验结果示列线图模型的一致性良好(χ;=4.805,P=0.684)。结论 基于pSOFA及心肺复苏持续时间的独立危险因素构建预测儿童院内心脏骤停预后的列线图模型,具有良好的区分度与校准度。Objectives To analyze the prognostic risk factors of in-hospital cardiac arrest(IHCA)in children,and to establish and evaluate the prognostic prediction nomogram model of them.Methods Guangdong Provincial People′s Hospital from January 2009 to December 2020 were enrolled. According to discharge outcomes,they were divided into survival group and death group. Comparison of clinical data between the two groups were analyzed. The prognostic independent risk factors of the IHCA children were analyzed by multivariate Logistic regression model. R software was used to establish the nomogram model to predict prognosis of the IHCA children.Bootstrap method was taken to have a internal verification,in addition,receiver operating characteristic curve(ROC)and calibration curve were used to evaluate the efficiency of model.Results There Were 29 survivors(38.7%)and 46deaths(61.3%). By univariate analysis,it showed significant differences in age,cardiac failure,hepatic insufficiency,pediatric sequential organ failure assessment(pSOFA),vasoactive-inotropic score(VIS)and duration of resuscitation between the two groups(P<0.05). For another,the prognostic independent risk factors of the IHCA children were p SOFA(OR=1.268,95%CI:1.005-1.601),duration of resuscitation between 10 and 30 minutes(OR=8.032,95%CI:1.487-43.378),and duration of resuscitation over 30 minutes(OR=46.263,95%CI:7.588-282.074)from multivariate Logistic regression analysis. A nomogram model was built based on aforesaid independent risk factors,its area under the curve(AUC)was 0.881(95%CI:0.803-0.959),calibration curve was close to ideal,and the results of Hosmer-Lemeshow goodness of fit test showed good consistency of the model(χ;=4.805,P=0.684).Conclusions has well discrimination and calibration to predict prognosis of the IHCA children,which based on the independent risk factors.

关 键 词：院内心脏骤停 预后 儿童 儿童序贯器官衰竭评分 列线图 

分 类 号：R541.78[医药卫生—心血管疾病]