个体化预测老年妇科恶性肿瘤术中急性压力性损伤风险Nomogram模型的构建及验证  

Construction and validation of a nomogram model for individualized prediction of the risk of acute intraoperative pressure injury in gynecologic malignancies in the elderly

作　　者：董玉娇 严丽洁[1] Dong Yujiao;Yan Lijie(Thr First Affiliated Hospital of Nanjing Medical University,Nanjing 210029)

机构地区：[1]南京医科大学第一附属医院,南京210029

出　　处：《现代妇产科进展》2024年第7期525-529,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:构建个体化预测老年妇科恶性肿瘤患者术中急性压力性损伤的风险Nomogram模型,并验证模型的预测能力。方法:选取2018年6月至2023年6月于江苏省人民医院行手术治疗的505例老年妇科恶性肿瘤患者,其中术中发生急性压力性损伤51例(损伤组)。采用单因素和多因素logistic回归分析老年妇科恶性肿瘤发生术中急性压力性损伤的危险因素,并建立相关Nomogram预测模型。结果:损伤组和非损伤组患者的肿瘤分期、术前Munro量表评分、术前ALB、术前血红蛋白(Hb)、手术时间、术中出血量和术中体温波动情况比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,Ⅲ~Ⅳ期肿瘤、术前Munro量表评分高、术前白蛋白(ALB)<35g/L、术前Hb<110g/L、手术时间≥180min、术中出血量≥500mL和术中体温波动较大是老年妇科恶性肿瘤患者发生术中急性压力性损伤的独立危险因素(P<0.05)。Nomogram模型验证结果,C-index指数为0.809(95%CI为0.781~0.836),Hosmer-Lemeshoe拟合优度检验显示,模型拟合较好(χ^(2)=4.308,P=0.117),ROC曲线的AUC为0.811(95%CI为0.783~0.839),在1%~80%的列线图可预测范围内,模型获益值均为正值。结论:老年妇科恶性肿瘤患者发生术中急性压力性损伤的危险因素包括Ⅲ~Ⅳ期肿瘤、术前Munro量表评分高、术前ALB<35g/L、术前Hb<110g/L、手术时间≥180min、术中出血量≥500mL和术中体温波动较大,基于上述因素构建的Nomogram模型对老年妇科恶性肿瘤患者术中急性压力性损伤发生风险具有较高的预测价值。Objective:To construct an individualized nomogram model for predicting the risk of acute intraoperative pressure injury in gynecologic malignancies in the elderly,and to validate the predictive ability of the model.Methods:505 geriatric gynecologic malignant tumor patients who underwent surgical treatment in Jiangsu Provincial People's Hospital from June 2018 to June 2023 were selected,among which 51 cases of intraoperative acute pressure injury occurred(injury group).Risk factors for intraoperative acute stress injury in geriatric gynecologic malignant tumors were analyzed by univariate and multivariate logistic regression,and the related nomogram prediction model was established.Results:Tumor stage,preoperative Munro scale score,preoperative ALB,preoperative Hb,operation time,intraoperative bleeding and intraoperative temperature fluctuation were compared between patients in the injury group and non-injury group,and the differences were statistically significant(P<0.05).Multifactorial logistic regression analysis showed that stageⅢ~Ⅳtumor,high preoperative Munro scale score,preoperative ALB<35g/L,preoperative Hb<110g/L,operative time≥180min,and intraoperative bleeding volume≥500mL and intraoperative temperature fluctuation were independent risk factors for intraoperative acute pressure injury in elderly patients with gynecologic malignancies(P<0.05).Nomogram model validation results:the C-index index was 0.809(95%CI:0.781~0.836),the Hosmer-Lemeshoe goodness-of-fit test showed a good model fit(χ^(2)=4.308,P=0.117),the AUC of the ROC curve was 0.811(95%CI:0.783~0.839),and the model benefit values were positive in the predictable range of 1%to 80%of the nomogram.Conclusions:Risk factors for the occurrence of intraoperative acute pressure injury in elderly patients with gynecologic malignancies include stageⅢ~Ⅳtumors,high preoperative Munro scale scores,preoperative ALB<35g/L,preoperative Hb<110 g/L,operative time≥180min,and intraoperative bleeding≥500mL and intraoperative temperature fluctuation.T

关 键 词：老年妇科恶性肿瘤 术中急性压力性损伤 危险因素 NOMOGRAM 模型验证 

分 类 号：R737.33[医药卫生—肿瘤]