尿道下裂患儿术后尿道并发症的危险因素及其风险评估模型的构建  

Construction of a risk assessment model for postoperative complications in children with hypospadias

作　　者：李誉彤 李宁秀[1] 袁秀梅[1] 吴双凤 宾丹[1] LI Yutong;LI Ningxiu;YUAN Xiumei;WU Shuangfeng;BIN Dan(Hunan Provincial Children's Hospital,Changsha 410000,China)

机构地区：[1]湖南省儿童医院,湖南省长沙市410000

出　　处：《护理实践与研究》2024年第7期1044-1050,共7页Nursing Practice and Research

摘　　要：目的探究尿道下裂患儿术后尿道并发症发生的影响因素,结合回归分析结果,构建风险评估模型并检验其效果。方法选择医院2020年4月—2022年8月收治的尿道下裂手术患儿200例为调查对象,采用一般资料问卷调查患儿基础信息,通过单因素分析、多因素Logistic回归分析,筛选尿道下裂患儿术后尿道并发症发生的影响因素,并据此构建尿道下裂患儿术后尿道并发症发生风险评估模型,检验其评估效果。结果术后发生尿道并发症的患儿42例为发生组,其余158例为未发生组。经单因素分析及多因素Logistic回归分析,尿道下裂患儿术后尿道并发症发生的影响因素有年龄、阴茎下弯程度、尿道缺损长度、切口感染、术后皮肤坏死、切口愈合、术后导尿通畅度(P<0.05)。其中,年龄>3岁、中重度阴茎下弯、尿道缺损长度≥4 cm、切口感染、术后皮肤坏死、切口愈合较差、引流不畅患者发生尿道并发症的危险性增大。尿道下裂患儿术后尿道并发症发生风险评估模型的Hosmer-Lemeshow检验显示差异无统计学意义(χ^(2)=0.318,P=0.573),提示拟合优度良好;受试者工作特征(ROC)曲线下面积为0.915(95%CI:0.869~0.950),最大约登指数为0.645。临床应用结果显示,以P≥0.536为预测发生术后尿道并发症的标准,模型预测的敏感度和特异度均达到90%以上,表明预测结果具有非常高的真实性,并且Kappa>0.75,表明预测结果与实际结果的一致性非常高。结论影响尿道下裂患儿术后尿道并发症的影响因素有年龄、阴茎下弯程度、尿道缺损长度、切口感染、术后皮肤坏死、切口愈合、术后导尿通畅度。根据回归方程构建的尿道下裂患儿术后尿道并发症风险评估模型预测结果的真实性和一致性较高。Objective To explore the influencing factors of postoperative urethral complications in children with hypospadias,and to construct a risk assessment model based on the results of regression analysis,followed by testing of its effectiveness.Methods A total of 200 children with hypospadias who underwent surgery in the hospital from April 2020 to August 2022 as the study subjects.General Information Questionnaire was used to investigate the basic information of the children.The influencing factors of postoperative urethral complications in children with hypospadias were screened through univariate analysis and multivariate Logistic regression analysis.Based on this,a risk assessment model for postoperative urethral complications in children with hypospadias was constructed and its assessment effectiveness was tested.Results The 42 children who developed postoperative urethral complications were in the occurrence group,while the remaining 158 were in the non-occurrence group.Univariate analysis and multivariate Logistic regression analysis showed that the factors influencing the occurrence of postoperative urethral complications in children with hypospadias include the age,degree of penile curvature,urethral defect length,incision infection,postoperative skin necrosis,incision healing,and degree of postoperative catheter patency(P<0.05).Specifically,the risk of urethral complications increased in patients with age>3 years,with moderate to severe penile curvature,urethral defect length≥4 cm,incision infection,postoperative skin necrosis,poor incision healing,and poor drainage.The Hosmer-Lemeshow test for the risk assessment model of postoperative urethral complications in children with hypospadias showed that the difference was not statistically significant(χ^(2)=0.318,P=0.573),indicating good fit.The area under the receiver operating characteristic(ROC)curve was 0.915(95%CI:0.869~0.950),with a maximum Youden index of 0.645.The clinical application results showed that using P≥0.536 as the criterion for predicting

关 键 词：尿道下裂患儿 尿道并发症 影响因素 风险评估模型 效果验证 

分 类 号：R473.6[医药卫生—护理学]