高龄阴道分娩产妇产后顽固性尿潴留发生风险预警模型的构建与验证  

Construction and verification of a risk warning model for refractory urinary retention in older women with vaginal delivery

作　　者：谢栩娟 XIE Xujuan(Ganzhou Maternal and Child Health Hospital,Ganzhou 341000)

机构地区：[1]江西省赣州市妇幼保健院,赣州341000

出　　处：《临床护理杂志》2023年第4期2-6,共5页Journal of Clinical Nursing

基　　金：赣州市卫生和计划生育委员会科研计划项目(2017-2-19)。

摘　　要：目的探究高龄阴道分娩产妇产后顽固性尿潴留发生的危险因素,并构建风险预警模型与验证。方法采用回顾性方法,选取2021年2月-2022年2月我院阴道分娩的高龄产妇253例为建模组,选取2022年3月-9月127例产妇作为验证组。根据是否发生产后顽固性尿潴留进行分组,收集产妇的基本资料及临床医疗信息,采用单因素及多因素Logistic回归分析影响产妇产后发生顽固性尿潴留的相关因素,并构建风险预警模型。采用受试者工作特性曲线(ROC)评估风险预警模型的预测价值。结果建模组253例高龄产妇中23例(9.09%)发生顽固性尿潴留。多因素Logistic分析结果显示,第二产程时间延长、产钳助产、会阴侧切、缩宫素使用是高龄产妇阴道分娩产后顽固性尿潴留发生的独立危险因素,产前排空膀胱是保护因素。内部验证结果显示,ROC曲线下面积为0.840(95%CI:0.731~0.949),敏感度为73.90%,特异度为93.00%,预测准确率为91.30%;外部验证结果显示,ROC曲线下面积为0.739(95%CI:0.584~0.893),敏感度为66.70%,特异度为76.00%,预测准确率为74.02%,且校准一致性较好。Hosmer-Lemeshow拟合优度检验结果显示,建模组χ^(2)=5.573,P=0.695,验证组χ^(2)=4.506,P=0.564,模型拟合情况良好。结论第二产程时间、产钳助产、会阴侧切、缩宫素、产前排空膀胱为高龄阴道分娩产妇产后顽固性尿潴留发生的独立影响因素,以此构建风险预测模型具有一定的预测效能。Objective To explore the risk factors of postpartum intractable urinary retention in elderly women with vaginal delivery,and build a risk warning model and verification.Methods A total of 253 elderly women who delivered vaginally in the delivery room of Ganzhou Maternal and Child Health Hospital from February 2021 to February 2022 were retrospectively selected as the modeling group,and 127 women who delivered vaginally from March 2022 to September 2022 were selected as the verification group.The groups were divided according to whether the occurrence of postpartum intractable urinary retention.The basic data and clinical medical information of the mothers were collected.The factors affecting the occurrence of postpartum intractable urinary retention were analyzed by single factor and multiple factor Logistic regression,and the risk warning model was built.The predictive value of risk prediction model was evaluated by receiver operating characteristic curve(ROC).Results Of 253 women in the modeling group,23(9.09%)had intractable urinary retention.Univariate analysis showed that primiparas,forceps assisted delivery,second-degree perineal laceration,perineotomy,labor analgesia,labor time,uterine closure and postpartum hemorrhage were the related factors affecting the occurrence of refractory postpartum urinary retention in elderly vaginal parturients.The results of multivariate analysis showed that the duration of second stage of labor,forceps assisted delivery,lateral perisiotomy,oxytocin were independent risk factors for intractable urinary retention in older women who delivered vaginalis.Emptying the bladder before delivery is a protective factor for the occurrence of refractory urinary retention in older women after vaginal delivery.ROC results showed that the area under the ROC curve(AUC)was 0.840(95%CI:0.731~0.949)for internal verification,the sensitivity was 73.90%and the specificity was 93.00%,the accuracy was 91.30%;and 0.739(95%CI:0.584~0.893)for external verification,the sensitivity was 66.70%,the specifi

关 键 词：阴道分娩 产后尿潴留 高龄产妇 风险预警模型 

分 类 号：R714.3[医药卫生—妇产科学] R714.64[医药卫生—临床医学]