剖宫产术后产妇泌乳Ⅱ期启动延迟风险预测模型的构建及验证  

Construction and validation of risk prediction model for delayed onset of lactogenesis stage Ⅱ following cesarean section

作　　者：丁娟[1] 连伟宁 马啸 Ding Juan;Lian Weining;Ma Xiao(Department of Quality Control,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Gynaecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院质量控制处,郑州450052 [2]郑州大学第一附属医院妇科,郑州450052

出　　处：《中华围产医学杂志》2022年第9期661-669,共9页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨剖宫产术后产妇泌乳Ⅱ期启动延迟(delayed onset of lactogenesis stageⅡ,DOLⅡ)的影响因素,并构建风险预测模型。方法选择2021年9月至2022年1月在郑州大学第一附属医院行剖宫产分娩的330例产妇作为研究对象,根据产后是否发生DOLⅡ分为DOLⅡ组(n=104)和非DOLⅡ组(n=226),并将2组产妇相关临床资料进行比较,利用单因素分析和logistic回归分析探讨剖宫产术后产妇DOLⅡ的影响因素,建立风险预测模型并绘制列线图,采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积检测模型的预测效能,Hosmer-Lemeshow检验判断模型的拟合优度。于2022年2月至3月选取129例在本院剖宫产分娩的产妇作为验证组对模型进行外部验证。结果建模组产后DOLⅡ发生率为31.5%(104/330),验证组为31.0%(40/129)。建模组中DOLⅡ组与非DOLⅡ组比较,孕前不同体重指数分组的构成比{偏瘦[9.7%(22/226)与3.8%(4/104)];正常[66.8%(151/226)与62.5%(65/104)]和超重或肥胖[23.5%(53/226)与33.7%(35/104)]},初产[50.4%(114/226)与61.5%(64/104)]、孕期接受过母乳喂养教育[64.2%(145/226)与40.4%(42/104)]和母婴分离[36.3%(82/226)与50.0%(52/104)]的产妇所占比例,分娩孕周[38.0(36.0~39.0)与37.0(35.0~38.5)周]和产后48 h内母乳喂养次数[6.0(3.0~9.0)与2.0(0.5~5.0)次]的比较,差异均有统计学意义(P值均<0.05)。最终纳入模型的预测变量为孕前超重或肥胖(OR=4.040,95%CI:1.196~13.651)、初产妇(OR=1.866,95%CI:1.079~3.227)、孕期接受过母乳喂养教育(OR=0.582,95%CI:0.339~1.000)、产后48 h内母乳喂养次数(OR=0.791,95%CI:0.729~0.857)。Hosmer-Lemeshow检验P=0.814,ROC曲线下面积为0.784(95%CI:0.731~0.837),约登指数为1.504,灵敏度为0.769,特异度为0.735。外部验证Hosmer-Lemeshow检验P=0.260,ROC曲线下面积为0.751(95%CI:0.661~0.840),约登指数为1.460,灵敏度为0.775,特异度为0.685。结论本研究构建的剖宫产术后DOLⅡ风险预测模型一致性和�Objective To explore the risk factors of delayed onset of lactogenesis stage Ⅱ(DOLⅡ)after cesarean section,and to establish a risk prediction model.Methods This study involved 330 women who underwent cesarean section in the First Affiliated Hospital of Zhengzhou University from September 2021 to January 2022 and were further divided into DOL Ⅱ group(n=104)or non-DOL Ⅱ group(n=226).All clinical data were compared.Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors of DOL Ⅱ after cesarean section to establish the risk prediction model and draw nomogram.The predictive validity of the model was evaluated by the area under the receiver operating curve(AUC)and the goodness of fit was verified by Hosmer-Lemeshow test.Another 129 women who underwent cesarean section in our hospital from February to March 2022 were recruited for external validation.Results The incidence of DOL Ⅱ in the model development and validation cohort were 31.5%(104/330)and 31.0%(40/129),respectively.In the model developing cohort,significant differences were shown in the constituent ratio of different groups of pre-pregnant body mass index{lean:[9.7%(22/226)vs 3.8%(4/104)];fit:[66.8%(151/226)vs 62.5%(65/104)];overweight or obsess:[23.5%(53/226)vs 33.7%(35/104)]},the proportion of primiparas[50.4%(114/226)vs 61.5%(64/104)],breastfeeding education during pregnancy[64.2%(145/226)vs 40.4%(42/104)]and maternal separation[36.3%(82/226)vs 50.0%(52/104)],and the gestational age at delivery[38.0(36.0-39.0)vs 37.0(35.0-38.5)weeks]and frequency of breastfeeding within 48 h post-delivery[6.0(3.0-9.0)vs 2.0(0.5-5.0)]between the DOL Ⅱ and non-DOI Ⅱ group(all P<0.05).The predictors included in the model were pre-pregnancy overweight or obese(OR=4.040,95%CI:1.196-13.651),primipara(OR=1.866,95%CI:1.079-3.227),breastfeeding education during pregnancy(OR=0.582,95%CI:0.339-1.000),and frequency of breastfeeding within 48 h after delivery(OR=0.791,95%CI:0.720-0.857).The Hosmer-Lemeshow test showed t

关 键 词：剖宫产术 泌乳障碍 影响因素分析 模型 统计学 围手术期护理 

分 类 号：R719.8[医药卫生—妇产科学]