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作 者:殷素凤 张震祥[1] 卞菲菲 YIN Sufeng;ZHANG Zhenxiang;BIAN Feifei(Department of Orthopedics,Jiangsu Taizhou People's Hospital,Taizhou 225300,China)
出 处:《浙江医学》2023年第16期1739-1743,共5页Zhejiang Medical Journal
摘 要:目的建立并验证髋部骨折患者术后输血风险列线图模型。方法选择2016年3月至2020年11月在泰州市人民医院接受手术治疗的髋部骨折患者950例,按随机数字表法分为建模队列665例和验证队列285例。建模队列患者依据患者是否发生术后输血,分为输血组120例和非输血组545例。通过电子病历系统收集可能影响建模队列患者术后输血的临床资料,采用多因素logistic回归分析识别术后输血的独立危险因素,建立列线图模型并作验证。结果多因素logistic回归分析显示,高龄、术前低Hb、围术期未使用氨甲环酸(TXA)、全麻(GA)是髋关节骨折患者发生术后输血的独立危险因素[(OR(95%CI)=1.04(1.02~1.08)、0.93(0.91~0.95)、1.97(1.13~3.55)、2.12(1.22~3.60)]。基于上述4个危险因素建立列线图模型,该模型的C-指数为0.864(95%CI:0.833~0.894)。校正曲线显示实际观测概率与预测概率具有良好的一致性。结论本研究基于高龄、术前低Hb、未使用TXA及GA建立的列线图模型能够相对准确地评估髋部骨折患者术后输血风险,指导术前评估并早期干预以降低术后输血率。Objective To establish and validate the blood transfusion risk nomogram model for patients with hip fracture.Methods A retrospective study of 950 patients with hip fracture who underwent surgical treatment in Jiangsu Taizhou People's Hospital from March 2016 to November 2020 was conducted.According to random number table,665 patients were assigned to the modeling cohort and 285 in the validation cohort.In the modeling cohort,120 received postoperative blood transfusion,while 545 did not.Demographic,sociological,clinical,and laboratory data that may influence postoperative blood transfusion risk modeling were collected through the electronic medical record system.Multivariate logistic regression model was used to identify the independent risk factors for postoperative blood transfusion to establish a nomogram model and verify it.Results Multivariate logistic regression model showed advanced age[OR(95%CI):1.04(1.02-1.08)],lower preoperative hemoglobin(Hb)[OR(95%CI):0.93(0.91-0.95)],perioperative non-use of tranexamic acid(TXA)[OR(95%CI):1.97(1.13-3.55)]and general anesthesia(GA)[OR(95%CI):2.12(1.22-3.60)]were independent risk factors for postoperative blood transfusion in patients with hip fracture.The above four risk factors were used to build the nomogram,and the C-index of this model was 0.864,95%CI:0.833-0.894.The calibration curve shows that the actual observation probability was in good agreement with the predicted probability.Conclusion The nomogram model developed in this study based on advanced age,lower preoperative Hb,perioperative non-use of TXA and GA can relatively accurately assess the risk of blood transfusion after hip fracture surgery,which can guide preoperative evaluation and early intervention to reduce the rate of blood transfusion after hip fracture surgery.
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