肺部微创术后患者首次下床活动发生直立性不耐受的风险预测模型构建及验证  

Development and validation of a risk prediction model for orthostatic intolerance in patients undergoing initial ambulation following minimally invasive lung surgery

作　　者：马静[1] 张远航 高雪 包莉云 王思佳 田欣彤 李葆华[2] Ma Jing;Zhang Yuanhang;Gao Xue;Bao Liyun;Wang Sijia;Tian Xintong;Li Baohud(Department of Thoracic Surgery,Peking University Third Hospital,Beijing 100191,China;Department of Nursing,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院胸外科,北京100191 [2]北京大学第三医院护理部,北京100191

出　　处：《中华现代护理杂志》2024年第35期4842-4848,共7页Chinese Journal of Modern Nursing

摘　　要：目的探讨肺部微创术后患者首次下床活动发生直立不耐受(OI)的影响因素,构建并验证风险预测模型有效性,旨在为临床医务人员提供高危人群的筛查工具。方法采用便利抽样法,选取2022年3月-2023年11月于北京大学第三医院胸外科行肺部微创手术的1000例患者为研究对象。采用简单随机分组法,按照8:2的比例将患者分为建模组(n=800)和内部验证组(n=200)。建模组采用单因素分析和Logistic回归分析术后发生OI的影响因素,运用R软件建立列线图模型并进行内部验证。采用受试者工作特征(ROC)曲线下面积(AUC)分析预测模型并进行内部验证。通过绘制校准图进行一致性检验,使用Hosmer-Lemeshow检验判断模型的拟合优度。结果肺部微创术后患者首次下床活动0I的发生率为37.2%(372/1000)。建模组Logistic回归分析显示,体重指数、术后1d引流量、术后静脉应用非留体抗炎药、首次下床活动疼痛评分是术后患者发生OI的影响因素(P<0.05),ROC曲线结果显示,建模组AUC为0.645,验证组AUC为0.694,模型预测效能较好。建模组与验证组校正曲线显示,预测结果与实际结果有较好的重合度(P>0.05)。结论本研究构建的风险预测模型能较好地预测术后首次下床活动OI的发生风险,有利于临床筛查OI高危人群,可为医护人员早期采取有针对性的预防措施提供借鉴。Objective To identify factors influencing orthostatic intolerance(OI)in patients during initial ambulation following minimally invasive lung surgery and develop and validate a risk prediction model to assist clinical practitioners in screening high-risk patients.Methods Totally 1000 patients who underwent minimally invasive lung surgery at the Department of Thoracic Surgery of Peking University Third Hospital from March 2022 to November 2023 were recruited by convenience sampling.Patients were randomly divided into a modeling group(n=800)and an internal validation group(n=200)in an 8:2 ratio.Univariate analysis and logistic regression were applied to determine risk factors for OI in the modeling group.R software was utilized to construct a nomogram model.The model's predictive performance was assessed using the area under the ROC curve(AUC)for both the modeling and validation groups.Calibration curves were plotted to evaluate consistency,and the Hosmer-Lemeshow test was conducted to confirm model fit.Results The incidence of OI during initial ambulation was 37.2%(372/1000).Logistic regression identified BMI,postoperative day 1 drainage volume,postoperative use of nonsteroidal anti-inflammatory drugs(NSAIDs),and initial ambulation pain score as independent risk factors for OI(P<0.05).The AUC for the nomogram model in the modeling group was 0.645,and 0.694 in the validation group,indicating good predictive accuracy.Calibration curves showed strong agreement between predicted and observed outcomes(P>0.05).Conclusions The constructed risk prediction model demonstrates good predictive ability for OI risk during initial ambulation following minimally invasive lung surgery,which can support clinical identification of high-risk patients.This tool may provide valuable guidance for implementing early,targeted preventive measures.

关 键 词：微创手术 肺部 首次下床活动 直立不耐受 预测模型 

分 类 号：R655.3[医药卫生—外科学]