脊柱外科患者术后静脉血栓危险因素分析及预测模型构建  

Risk factors for postoperative venous thromboembolism in patients in department of spinal surgery and construction of predictive model

作　　者：仇铁英[1] 高素园 王卫星[1] 黄金[1] 李海洋[1] Qiu Tieying;Gao Suyuan;Wang Weixing;Huang Jin;Li Haiyang(Clinical Nursing Teaching and Research Section,the Second Xiangya Hospital of Central South University,Changsha 410010,China)

机构地区：[1]中南大学湘雅二医院临床护理教研室,长沙410010

出　　处：《中华现代护理杂志》2022年第20期2694-2700,共7页Chinese Journal of Modern Nursing

基　　金：2021年湖南省自然科学基金(2021JJ40825)。

摘　　要：目的筛选脊柱外科患者术后发生静脉血栓栓塞症(VTE)的危险因素,建立风险预测模型并进行外部验证。方法本研究为病例对照研究,采用方便抽样的方法,选取2019年5月—2021年4月中南大学湘雅二医院收治的93例行脊柱手术并发生VTE的患者为血栓组,并选同期100例行脊柱手术未发生VTE的患者作为对照组。采用自行设计的脊柱外科手术患者发生VTE的相关危险因素调查表对患者进行调查。采用二项Logistic回归分析脊柱外科患者术后发生VTE的危险因素,应用R软件建立列线图预测模型。选择2021年5—6月脊柱外科46例患者(发生、未发生VTE患者各23例)对预测模型进行验证。结果年龄[OR=1.603,95%置信区间(CI):1.036~2.483]、手术时间(OR=0.253,95%CI:0.123~0.518)、使用内固定(OR=0.128,95%CI:0.043~0.384)、应用骨水泥(OR=0.176,95%CI:0.048~0.652)、D-二聚体(OR=0.360,95%CI:0.147~0.884)、血浆纤维蛋白原降解产物(OR=0.024,95%CI:0.006~0.091)是脊柱外科患者术后发生VTE的危险因素。根据危险因素建立预测模型,模型的准确度为0.865,灵敏度为0.742;对模型进行外部验证,准确度为0.761,特异性为0.565,受试者工作特征曲线下面积为0.810。结论年龄、手术时间、使用内固定、应用骨水泥、D-二聚体、血浆纤维蛋白原降解产物是脊柱外科患者术后发生VTE的危险因素;根据危险因素建立的预测模型能够预测脊柱外科患者发生VTE的风险。Objective To screen risk factors of postoperative venous thromboembolism(VTE)in patients in department of spinal surgery and establish a risk prediction model and conduct external validation.Methods This study was a case-control study.Using the convenient sampling method,a total of 93 patients with VTE who underwent spinal surgery from May 2019 to April 2021 in the Second Xiangya Hospital of Central South University were selected as as the thrombosis group,while 100 patients who underwent spinal surgery without VTE during the same period were selected as the control group.A self-designed questionnaire about the risk factors of VTE in patients undergoing spinal surgery was used to investigate the patients.Binomial Logistic regression was used to analyze the risk factors of postoperative VTE in patients with spinal surgery and R software was used to establish a nomogram prediction model.A total of 46 patients(23 patient with VTE and 23 patients without VTE)from Department of Spinal Surgery from May and June 2021 were selected to verify the prediction model.Results Age(OR=1.603,95%CI:1.036-2.483),operation time(OR=0.253,95%CI:0.123-0.518),use of internal fixation(OR=0.128,95%CI:0.043-0.384),application of bone cement(OR=0.176,95%CI:0.048-0.652),D-dimer(OR=0.360,95%CI:0.147-0.884)and plasma fibrinogen degradation product(OR=0.024,95%CI:0.006-0.091)were risk factors for VTE in spinal surgery patients.The prediction model was established according to the risk factors.The prediction agreement rate of the model was 0.865 and the sensitivity was 0.742.The model was externally validated with a sensitivity of 0.761,a specificity of 0.565 and an area under the receiver operating characteristic curve of 0.810.Conclusions Age,operation time,use of internal fixation,application of bone cement,D-dimer and plasma fibrinogen degradation products are risk factors for postoperative VTE in patients with spinal surgery.Predictive models based on risk factors can predict the risk of VTE in spinal surgery patients.

关 键 词：静脉血栓栓塞症 脊柱外科 危险因素 预测模型 

分 类 号：R687.3[医药卫生—骨科学]