骨科术中病人深静脉血栓发生风险预测模型的构建与验证  

Construction and validation of a risk prediction model for deep vein thrombosis in orthopedic patients during surgery

作　　者：吕梦爽 郑喜灿[2] 谢素丽 孙志艳[2] 瞿靖芮 刘瑞婷 LYU Mengshuang;ZHENG Xican;XIE Suli;SUN Zhiyan;QU Jingrui;LIU Ruiting(School of Nursing,Xinxiang Medical University,Henan 450000 China)

机构地区：[1]新乡医学院护理学院,河南450000 [2]中国人民解放军联勤保障部队第988医院

出　　处：《护理研究》2024年第10期1711-1718,共8页Chinese Nursing Research

基　　金：河南省卫生与健康委员会联合共建项目,编号:LHGJ20210818。

摘　　要：目的:构建骨科术中病人深静脉血栓(DVT)发生风险预测模型,并对其进行验证。方法:于2021年1月—2022年12月,选取我院收治的需要进行骨科手术治疗的病人作为研究对象。将2021年1月—2022年4月符合标准的272例行骨科手术的病人作为建模组,将2022年5月—12月符合标准的151例行骨科手术的病人作为外部验证组。对病人一般资料、既往病史、实验室检查指标、手术室指标进行调查,分析骨科术中病人DVT发生的影响因素,构建预测模型,绘制列线图。结果:423例病人中97例发生DVT,DVT发生率为23%。多因素分析结果显示,年龄、体质指数(BMI)、D-二聚体、手术时长、术中是否输血、术中出血量和是否使用骨水泥是骨科术中病人DVT发生的影响因素,基于影响因素构建的风险预测模型拟合优度检验结果显示,χ^(2)=1.643,P=0.897。模型组受试者工作特征曲线下面积(AUC)为0.872,约登指数最大值为0.750,最佳临界值为0.079,灵敏度为75%,特异度为86%;外部验证组AUC为0.837,约登指数最大值为0.728时,对应的灵敏度为72%,特异度为82%,诊断值为0.165。结论:年龄、体质指数、D-二聚体、手术时长、术中是否输血、术中出血量和是否使用骨水泥对骨科病人DVT发生情况具有影响,基于影响因素构建的模型可较好地预测骨科术中病人DVT发生风险。Objective:To construct a risk prediction model for deep vein thrombosis(DVT)in orthopedic patients during surgery and verify it.Methods:Patients admitted to our hospital who require orthopedic surgery treatment were selected as the research subjects from January 2021 to December 2022.272 patients undergoing orthopedic surgery from January 2021 to April 2022 were selected as the modeling group,and 151 patients undergoing orthopedic surgery from May to December 2022 were selected as the external validation group.Patient general information,medical history,laboratory test indicators,and operating room indicators were investigated.The influencing factors of DVT in orthopedic patients during surgery were analyzed.A predictive model was constructed.And Nomogram was drawn.Results:Among 423 patients,97 patients with DVT,the incidence of DVT was 23%.The results of multivariate analysis showed that age,body mass index(BMI),D-dimer,surgical duration,whether blood transfusion was performed during surgery or not,intraoperative bleeding volume,and whether bone cement was used or not were the influencing factors of DVT in orthopedic patients during surgery.The goodness of fit test results of the risk prediction model constructed based on these influencing factors showed that,χ^(2)=1.643,P=0.897.Area under the curve(AUC)of receiver operator characteristic of the modeling group was 0.872,the maximum value of the Youden index was 0.750,the optimal critical value was 0.079,the sensitivity was 75%,and the specificity was 86%.The AUC of receiver operator characteristic of the external validation group was 0.837,the maximum value of Youden index was 0.728,the sensitivity was 72%,the specificity was 82%,and the diagnostic value was 0.165.Conclusions:Age,body mass index(BMI),D-dimer,surgical duration,whether blood transfusion was performed during surgery or not,intraoperative bleeding volume,and whether bone cement was used or not have effect on DVT in orthopedic patients.The model constructed based on these influencing factors can bet

关 键 词：骨科 手术 术中 深静脉血栓(DVT) 影响因素 风险预测模型 护理 

分 类 号：R473.6[医药卫生—护理学]