2岁及以下儿童肠套叠非手术复位失败的危险因素及预测模型  

Risk factors and prediction model for failed nonsurgical reduction of intussusception in children aged 2 years and below

作　　者：郭宏溪 杨俊[1] 卞红强[1] 郭琴[1] Guo Hongxi;Yang Jun;Bian Hongqiang;Guo Qin(Department of General Surgery,Wuhan Children's Hospital(Municipal Maternal&Children's Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430015,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)普外科,武汉430015

出　　处：《中华小儿外科杂志》2024年第8期704-710,共7页Chinese Journal of Pediatric Surgery

基　　金：武汉儿童医院临床研究人才培养项目(2023WHET-TFJH)。

摘　　要：目的探讨2岁及以下儿童原发性肠套叠非手术复位失败的危险因素及预测模型构建。方法收集2021年6月至2022年6月于武汉儿童医院确诊并行非手术复位的2岁及以下的肠套叠住院患儿281例的临床资料,其中男195例,女86例,年龄为(16.46±10.97)个月。根据灌肠复位结果将其分为成功组234例和失败组47例。分析人口统计学、临床表现、实验室检查、超声征象及灌肠复位方式等临床数据资料。对两组数据行独立样本t检验、χ^(2)检验、Mann-Whitney U检验等单因素分析,将两组比较差异有统计学意义的指标作为自变量纳入多因素二元logistic回归分析,筛选出肠套叠患儿非手术复位失败的危险因素,构建列线图预测模型,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),以曲线下面积(area under the curve,AUC)进行效能评价,并运用验证集数据对模型进行验证。结果单因素分析结果显示,失败组患儿中年龄<1岁、病程≥48 h、呕吐、血便、腹胀、发热、包块位于左侧腹、腹腔积液、肠壁血流信号异常、水灌肠复位比例和C反应蛋白水平、套入长度均高于成功组,血红蛋白、血钠水平均低于成功组,差异均有统计学意义(均P<0.05)。二元logistic回归分析结果显示,年龄<1岁(OR=27.70,95%CI:6.06~126.62)、呕吐(OR=0.05,95%CI:0.01~0.28)、腹胀(OR=0.11,95%CI:0.02~0.70)、血红蛋白降低(OR=1.06,95%CI:1.01~1.10)、包块位于左侧腹(OR=0.04,95%CI:0.01~0.20)和套入长度长(OR=0.49,95%CI:0.32~0.76)是肠套叠患儿非手术复位失败的危险因素(均P<0.05)。预测模型预测肠套叠患儿非手术复位失败的ROC曲线的AUC为0.975(95%CI:0.957~0.995,P<0.001),灵敏度为94.9%,特异度为87.2%;验证集中预测模型预测肠套叠患儿非手术复位失败的ROC曲线AUC为0.966(95%CI:0.937~0.995,P<0.001),灵敏度为90.0%,特异度为95.7%。结论年龄<1岁、呕吐、腹胀、血红蛋白降低、包块位置�Objective To explore the risk factors for nonsurgical reduction failure and to construct a clinical prediction model in children with intussusception.Methods From June 2021 to June 2022,retrospective analysis was performed for 281 hospitalized children with intussusception aged 2 years and below undergoing nonsurgical reduction.There were 195 boys and 86 girls with a mean age of(16.46±10.97)months.Based upon the results of enema reduction,they were assigned into two groups of success(n=234)and failure(n=47).Demographic profiles,clinical manifestations,laboratory tests,ultrasonic signs and enema reduction modes were recorded.The clinical data of two groups were statistically analyzed with one-way analysis of independent sample t,chi-square and Mann-Whitney U tests.Parameters with statistically significant inter-group differences were included as variables for multivariate logistic regression analysis to screen out the risk factors of nonsurgical reduction failure.And a nomogram was constructed for establishing a prediction model.The validation dataset was utilized for validating the model.Receiver operating characteristic(ROC)curve for predicting nonsurgical reduction failure by the prediction model was plotted and area under the ROC curve(AUC)calculated.Results Univariate analysis indicated that proportion of age,duration of symptoms,vomiting,hematochezia,abdominal distension,fever,location of mass,peritoneal fluid,abnormal blood flow signal on ultrasonic scans,proportion of enema reduction,level of C-reactive protein(CRP)and length of intestinal invagination were all higher in failure group than those in success group while the levels of hemoglobin(Hb)and sodium(Na)were lower than those in success group(all P<0.05).Binary logistic regression analysis showed that age under 1 year(OR=27.70,95%CI:6.06-126.62),vomiting(OR=0.05,95%CI:0.01-0.28),abdominal distension(OR=0.11,95%CI:0.02-0.70),lower Hb(OR=1.06,95%CI:1.01-1.10),left-sided mass(OR=0.04,95%CI:0.01-0.20)and longer intestinal invagination(OR=0.49,95%CI:0.32-

关 键 词：肠套叠 灌肠 危险因素 列线图 

分 类 号：R726.5[医药卫生—儿科]