婴幼儿颅内肿瘤术中大出血风险评分模型的建立  

Establishment of a risk scoring model to predict intraoperative massive hemorrhage in infants with intracranial tumors

作　　者：刘建华 张娜[1] 徐颖怡 魏伟[1] 陈程 谭永红 Liu Jianhua;Zhang Na;Xu Yingyi;Wei Wei;Chen Cheng;Tan Yonghong(Department of Anaesthesia and Prioperative,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China;不详)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心麻醉与围术期科,广州510623 [2]广州医科大学附属广州市妇女儿童医疗中心颅脑外科,广州510623

出　　处：《新医学》2022年第8期575-581,共7页Journal of New Medicine

基　　金：广州市卫生健康科技项目(20191A011034)。

摘　　要：目的分析婴幼儿颅内肿瘤切除术中大出血的影响因素,建立大出血风险评分模型。方法收集278例择期行颅内肿瘤切除手术的患儿,根据术中失血量(BL)与估计血容量(EBV)的比值(BL/EBV),分为中小出血组(BL/EBV≤0.5)和大出血组(BL/EBV>0.5),统计相关临床资料及出血情况,采用单因素和多因素logistic回归分析术中大出血的危险因素,构建大出血风险评分模型。选取45例行颅内肿瘤切除术患儿,绘制受试者操作特征(ROC)曲线评价模型性能。结果中小出血组患儿183例,大出血组患儿95例。Logistic回归分析显示术中大出血的危险因素为体质量≥12 kg、肿瘤直径≥4.5 cm,手术时间≥5 h(P均<0.05)。设定肿瘤直径≥4.5 cm分值为5分,手术时间≥5 h为2分,计算患儿的总分值即为大出血风险评分,该模型在回顾性人群的ROC曲线下面积为0.788。根据ROC曲线确定5分为是否大出血的临界值,灵敏度为66.8%,特异度为81.3%,准确率为71.0%;在前瞻性人群中,ROC曲线下面积为0.909,灵敏度、特异度、准确率分别为78.6%、88.9%、87.0%。结论颅内肿瘤切除术婴幼儿肿瘤直径≥4.5 cm、手术时间≥5 h是导致术中大出血的独立危险因素,以此建立的大出血风险评分模型对婴幼儿颅内肿瘤术中大出血具有较好的预测能力。Objective To analyze the factors influencing intraoperative massive hemorrhage in infants with intracranial tumors and establish a bleeding risk scoring(BRS)model.Methods Clinical data of 278 infants who underwent elective intracranial tumor resection were retrospectively analyzed.According to the ratio of blood loss(BL)to estimated blood volume(EBV),all infants were divided into the slight or moderate hemorrhage group(BL/EBV≤0.5)and massive hemorrhage group(BL/EBV>0.5).Relevant clinical data and hemorrhage were statistically analyzed.Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for intraoperative massive hemorrhage and establish a BRS model.Forty-five infants undergoing intracranial tumor resection were recruited in this study.The receiver operating characteristic(ROC)curve was delineated to evaluate the performance of this model.Results One hundred and eighty-three infants were assigned into in the slight or moderate hemorrhage group and 95 in the massive hemorrhage group.Logistic regression analysis demonstrated that body weight≥12 kg,tumor diameter≥4.5 cm,and operation time≥5 h were the independent risk factors for intraoperative massive hemorrhage(all P<0.05).The score of tumor diameter≥4.5 cm was set as 5,and 2 for operation time≥5 h.The total score of infant was calculated as BRS.The area under the ROC curve(AUC)of BRS model in the retrospective population was 0.788.If the critical value for massive hemorrhage was determined as 5,the sensitivity was 66.8%,the specificity was 81.3%,and the accuracy was 71.0%,while in the prospective population,the ROC AUC was 0.909,the sensitivity,specificity and accuracy were 78.6%,88.9%and 87.0%,respectively.Conclusions Preoperative tumor diameter≥4.5 cm and operation time≥5 h are the independent risk factors for intraoperative massive hemorrhage in infants undergoing intracranial tumor resection.The BRS model established based on these factors has high predictive ability for intraoperative mas

关 键 词：肿瘤 手术 大出血 影响因素 模型 

分 类 号：R739.41[医药卫生—肿瘤]