老年胃肠道肿瘤患者术后衰弱风险预测模型的构建及评价  

Establishment and evaluation of a nomogram model for predicting postoperative frailty in elderly patients with gastrointestinal tumors

作　　者：李佳佳 赵梅[1] 王梅[2] 张超[2] Li Jiajia;Zhao Mei;Wang Mei;Zhang Chao(School of Nursing,Anhui Medical University,Hefei 230601,China;Emergency Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学护理学院,合肥230601 [2]安徽医科大学第一附属医院急诊外科,合肥230022

出　　处：《中国实用护理杂志》2024年第3期181-188,共8页Chinese Journal of Practical Nursing

基　　金：安徽高校人文社会科学研究项目重大项目(SK2021ZD0030)。

摘　　要：目的分析老年胃肠道肿瘤患者术后衰弱影响因素,构建术后衰弱发生风险的预测模型并评价其效能,为后期制订老年胃肠道肿瘤患者围手术期衰弱管理方案提供参考依据。方法采用便利抽样法,选取2021年12月至2022年8月安徽医科大学第一附属医院收治的376例行手术治疗的老年胃肠道肿瘤患者为研究对象。术后第5天依据Tilburg衰弱量表诊断患者是否发生术后衰弱,将其分为术后衰弱组和术后非衰弱组。收集患者的一般资料、实验室指标、临床资料,采用单因素分析与多因素Logistic回归分析筛选老年胃肠道肿瘤患者术后衰弱的独立影响因素,采用R软件构建列线图预测模型并进行内部验证,评价该模型的区分度、校准度和临床适用性。结果本研究调查对象男265例,女111例,年龄(70.04±5.89)岁,其中222例占59.0%的患者发生了术后衰弱。多因素分析显示,Barthel指数评分低(OR=0.941,95%CI 0.903~0.980)、低血红蛋白(OR=0.976,95%CI 0.963~0.989)、查尔森合并症指数评分高(OR=1.457,95%CI 1.128~1.882)、术前衰弱(OR=4.369,95%CI 1.486~12.841)、病理分期为Ⅲ~Ⅳ期(OR=2.053,95%CI 1.253~3.364)是老年胃肠道肿瘤发生术后衰弱的独立影响因素(均P<0.05)。列线图模型内部验证前后的AUC分别为0.811(95%CI 0.768~0.854)、0.803(95%CI 0.762~0.856),Hosmer-Lemeshow检验结果显示拟合优度良好(χ^(2)=4.09,P>0.05),决策曲线分析表明模型具有一定的临床适用性。结论基于老年胃肠道肿瘤患者术后衰弱风险的危险因素建立列线图预测模型,具有较好的区分度、一致性及临床适用性,可为临床医护人员制订围手术期衰弱管理方案提供参考依据。Objective To analyze the influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors,establish a nomogram model for predicting postoperative frailty and evaluate its efficacy,so as to provide reference basis for formulating perioperative frailty management plans for elderly gastrointestinal tumor patients in the later stage.Methods Convenience sampling method was used to select 376 elderly patients with gastrointestinal tumors who underwent surgical treatment in the First Affiliated Hospital of Anhui Medical University from December 2021 to August 2022 as the study objects.On the 5th day after surgery according to Tilburg Frailty Indicator,the patients were diagnosed whether they developed postoperative frailty and were divided into postoperative frailty group and postoperative non-frailty group.General data,laboratory indicators and clinical data of patients were collected.Univariate analysis and multivariate Logistic regression analysis were used to screen the independent influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors.R software was used to establish a nomogram prediction model and conduct internal validation to evaluate the differentiation,calibration and clinical applicability of the model.Results A total of 265 males and 111 females included aged(70.04±5.89)years old,with 222(59.0%)patients experienced postoperative frailty in this study.Multivariate analysis showed that low Barthel Index score(OR=0.941,95%CI 0.903-0.980),low hemoglobin(OR=0.976,95%CI 0.963-0.989),high Charison Comorbid Index score(OR=1.457,95%CI 1.128-1.882),preoperative frailty(OR=4.369,95%CI 1.486-12.841),and pathological stageⅢ-Ⅳ(OR=2.053,95%CI 1.253-3.364)were independent influencing factors for postoperative frailty of elderly gastrointestinal tumors(all P<0.05).The AUC before and after internal validation of the nomogram model was 0.811(95%CI 0.768-0.854)and 0.803(95%CI 0.762-0.856)respectively.The results of Hosmer-Lemeshow test showed good goodness

关 键 词：老年人 胃肠道肿瘤 术后衰弱 影响因素 列线图 

分 类 号：R473.73[医药卫生—护理学]