初训学员发生内镜逆行胰胆管造影相关不良事件影响因素分析及预测模型构建的前瞻性研究  

Influencing factors for endoscopic retrograde cholangiopancreatography‐related adverse events in novice trainees and establishment of its prediction model:a prospective study

作　　者：马玉虎 岳平[2] 杨曼[1] 刘浩然 张金铎 王海平[2] 王芳昭 孟文勃[2] Joseph W.Leung 李汛[2] Ma Yuhu;Yue Ping;Yang Man;Liu Haoran;Zhang Jinduo;Wang Haiping;Wang Fangzhao;Meng Wenbo;Joseph W.Leung;Li Xun(The First School of Clinical Medicine,Lanzhou University,Lanzhou 730030,China;Department of General Surgery,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Gastrointestinal Diseases,UC Davis Medical Center,Sacramento 95817,United States)

机构地区：[1]兰州大学第一临床医学院,兰州730030 [2]兰州大学第一医院普通外科,兰州730030 [3]加州大学Davis医疗中心胃肠病学系,萨克拉门托95817

出　　处：《中华消化外科杂志》2022年第7期892-900,共9页Chinese Journal of Digestive Surgery

基　　金：甘肃省科技计划项目(20YF8WA085)。

摘　　要：目的探讨初训学员发生内镜逆行胰胆管造影(ERCP)相关不良事件的影响因素及预测模型构建。方法采用前瞻性研究方法。选取2016年7月至2019年7月兰州大学第一医院12名ERCP初训学员的临床资料。ERCP初训学员均在内镜专家带教下施行标准ERCP。观察指标:(1)初训学员发生ERCP相关不良事件情况。(2)初训学员发生ERCP相关不良事件影响因素分析。(3)初训学员发生ERCP相关不良事件预测模型构建。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann‑Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。单因素和多因素分析采用Logistic回归模型。采用回归系数构建预测模型。绘制受试者工作特征曲线,以曲线下面积进行效能评价。结果(1)初训学员发生ERCP相关不良事件情况。12名初训学员施行300例ERCP,发生ERCP相关不良事件52例,无不良事件248例。初训学员发生ERCP相关不良事件的ERCP难度分级(1~2级、3~4级),进镜时间,插管时间,完成插管(是、否),网篮取石(是、否),狭窄扩张(是、否),造影解读,实施合理治疗,达到预期目的分别为22、30例,8(5~10)分,20(9~20)分,24、28例,11、41例,0、52例,(39±17)分,(39±19)分,(44±23)分;无不良事件初训学员上述指标分别为146、102例,6(4~9)分,12(8~20)分,163、85例,94、154例,20、228例,(52±22)分,(80±20)分,(52±23)分;两者上述指标比较,差异均有统计学意义(χ^(2)=4.79,Z=-2.46、-2.72,χ^(2)=7.01、5.30、4.49,t=-4.00、-2.97、-2.29,P<0.05)。(2)初训学员发生ERCP相关不良事件影响因素分析。单因素分析结果显示:ERCP难度分级、进镜时间、插管时间、完成插管、网篮取石、造影解读、实施合理治疗、达到预期目的是影响初训学员发生ERCP相关不良事件的相关因素(优势比=1.95,1.11,1.08,0.45,0.44,0.97,0.98,0.98,95%可信区间为1Objective To investigate the influencing factors for endoscopic retrograde cholangiopancreatography(ERCP)‐related adverse events in novice trainees and establishment of its prediction model.Methods The prospective study was conducted.The clinical data of 12 novice trainees of ERCP in the First Hospital of Lanzhou University from July 2016 to July 2019 were selected.The operation was performed by 12 novice trainees of ERCP under the guidance of the endoscopic experts.Observation indicators:(1)ERCP-related adverse events in novice trainees;(2)analysis of influencing factors for ERCP-related adverse events in novice trainees;(3)establishment of a prediction model for ERCP-related adverse events in novice trainees.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented as M(range),and com-parison between groups was analyzed by the Mann-Whitney U test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed by the chi-square test.The Logistic regression model was used for univariate and multivariate analyses.The regression coefficients were used to construct a prediction model.The receiver operating characteristic curve was drawn,and the area under curve was used to evaluate the predictive ability.Results(1)ERCP-related adverse events in novice trainees.Of the 300 patients with ERCP operated by 12 novice trainees,52 cases had ERCP-related adverse events and 248 cases had no ERCP-related adverse events.Cases in grade 1‒2 or grade 3‒4 of ERCP difficulty classification,score for intubation time,score for cannulation times with or without completion of the cannulation,cases with or with-out basket stone removal,cases with or without stenosis expansion,score for contrast-enhanced interpretation,score for implementation of reasonable treatment and score for expected purpose reached were 22,30,8(range,5‒10),20(rang,9‒20),24,28,11,41,0,52,39

关 键 词：胆道疾病 胰腺疾病 内镜逆行胰胆管造影 标准化培训 不良事件 影响因素 

分 类 号：R197.323[医药卫生—卫生事业管理]