酒精性肝硬化合并胆囊结石术后胃肠道症状的列线图预测模型构建  

Construction of nomographic chart predictive model for gastrointestinal symptoms after operation of alcoholic cirrhosis complicated with cholecystolithiasis

作　　者：刘佳 LIU Jia(Department of Gastroenterology,Xingtai General Hospital,North China Medical and Health Group,Xingtai,Hebei 054000,China)

机构地区：[1]华北医疗健康集团邢台总医院消化外科,河北邢台054000

出　　处：《临床外科杂志》2024年第8期848-853,共6页Journal of Clinical Surgery

基　　金：河北省2020年度医学科学研究课题计划(202001120)。

摘　　要：目的构建酒精性肝硬化(ALC)合并胆囊结石术后胃肠道症状的列线图模型并验证其预测价值。方法2021年10月~2022年10月在我院接受治疗的ALC合并胆囊结石病人100例,行腹腔镜胆囊切除术治疗,收集病人相关资料,统计病人术后胃肠道症状发生情况和胃肠道症状评分,根据胃肠道症状评估结果分为轻度组和中重度组,采用单因素及多因素Logistic回归分析病人术后胃肠道症状严重程度影响因素,并构建列线图预测模型,利用ROC曲线、校准曲线、DCA曲线对该模型进行评价和验证。结果轻、中重度术后胃肠道症状病人年龄、术中血压异常、术后早期进食、术后早期下床运动、超前镇痛、焦虑自评量表(SAS)评分、术后使用促胃肠动力药、手术时间比较,差异有统计学意义(P<0.05);模型组年龄、术中血压异常、术后早期进食、术后早期下床运动、超前镇痛、手术时间、SAS评分、促胃肠动力药物是病人术后胃肠道症状严重程度的影响因素(P<0.05);基于以上因素构建列线图预测模型,ROC曲线、校准曲线、DCA曲线提示该预测模型具有较好的预测能力,且精准区分度良好。结论ALC合并胆囊结石术后胃肠道症状严重程度的影响因素包括年龄、术中血压异常、术后早期进食、术后早期下床运动、手术时间、超前镇痛、SAS评分、术后使用促胃肠动力药,将以上因素构建列线图预测模型,具有较好预测效能。Objective To construct the nomographic chart model for gastrointestinal symptoms after operation of alcoholic cirrhosis complicated with cholecystolithiasis and to explore its predictive value.Methods One hundred patients with ALC complicated with gallbladder stones who received treatment in our hospital from October 2021 to October 2022 were selected for surgical treatment,collect relevant patient data and analyze the occurrence of postoperative gastrointestinal symptoms and their scores,based on the evaluation results of gastrointestinal symptoms,patients are divided into mild and moderate to severe groups,analyze the factors affecting the severity of postoperative gastrointestinal symptoms,and construct a column chart prediction model;evaluate and validate the model using ROC curves,calibration curves,and DCA curves.Results Patients with mild to moderate to severe postoperative gastrointestinal symptoms showed statistically significant differences in age,intraoperative blood pressure abnormalities,early postoperative eating,early postoperative bed movement,advanced analgesia,anxiety self-assessment scale(SAS)scores,postoperative use of gastrointestinal motility drugs,and surgical time(P<0.05);Age,intraoperative abnormal blood pressure,early postoperative eating,early postoperative bed movement,preemptive analgesia,surgical time,SAS score,and gastrointestinal motility promoting drugs of the model group were influencing factors for the severity of postoperative gastrointestinal symptoms in patients(P<0.05);building a column chart prediction model based on the above factors,ROC,calibration curve,and DCA indicate that the prediction model has good predictive ability and clinical effectiveness,and has good accuracy and differentiation.Conclusion The factors influencing the severity of gastrointestinal symptoms after surgery for ALC combined with gallbladder stones include age,abnormal intraoperative blood pressure,early postoperative feeding,early postoperative bed exercise,duration of surgery,over-the-counter anal

关 键 词：列线图预测模型 酒精性肝硬化 胆囊结石 腹腔镜胆囊切除术 胃肠道症状 

分 类 号：R575.2[医药卫生—消化系统] R657.4[医药卫生—内科学]