严重烧伤患者并发肺动脉栓塞风险预测模型的建立与验证  

Establishment and validation of a risk prediction model for pulmonary embolism in severe burn patients

作　　者：姜胜攀 高小青 栾夏刚 谭一清 Jiang Shengpan;Gao Xiaoqing;Luan Xiagang;Tan Yiqing(Department of Interventional Medicine,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China;Department of Clinical Laboratory,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China;Department of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院介入医学科,武汉430060 [2]武汉大学同仁医院暨武汉市第三医院检验科,武汉430060 [3]武汉大学同仁医院暨武汉市第三医院烧伤科,武汉430060

出　　处：《中华烧伤与创面修复杂志》2024年第12期1114-1122,共9页Chinese Journal of Burns And Wounds

基　　金：湖北省卫生健康委2019-2020年度项目(WJ2019F004);2019年湖北省知识创新专项(自然科学基金)项目(2019CFC917);武汉市卫生与计划生育委员会科研项目(WX16D13)。

摘　　要：目的筛选严重烧伤患者并发肺动脉栓塞的危险因素,据此构建风险预测模型并进行验证。方法该研究为回顾性病例系列研究。收集2020年3月-2023年3月武汉市第三医院烧伤科收治的符合入选标准的267例严重烧伤患者的临床资料,其中男159例、女108例,年龄18~82岁。根据是否并发肺动脉栓塞将患者分为肺动脉栓塞组(26例)与非肺动脉栓塞组(241例),收集并比较2组患者性别、年龄、体重指数、治疗期间卧床时间、烧伤原因、入院时白蛋白水平、合并慢性阻塞性肺疾病(COPD)情况、合并糖尿病情况、合并高血压情况、合并吸入性损伤情况和入院时简明烧伤严重指数(ABSI)评分。对组间比较差异有统计学意义的指标进行单因素和多因素logistic回归分析,筛选267例严重烧伤患者并发肺动脉栓塞的独立危险因素,并据此构建列线图预测模型。通过受试者操作特征(ROC)曲线评估预测模型的性能,采用校准曲线和临床决策曲线分析法对预测模型进行验证。结果肺动脉栓塞组患者中>60岁、治疗期间卧床时间>7 d、合并COPD、合并糖尿病患者比例(χ^(2)值分别为7.75、29.15、29.86、5.94),入院时ABSI评分(t=6.01)均明显高于非肺动脉栓塞组(P<0.05)。2组患者其余资料比较,差异均无统计学意义(P>0.05)。单因素logistic回归分析显示,年龄、治疗期间卧床时间、合并COPD、合并糖尿病、入院时ABSI评分均为严重烧伤患者并发肺动脉栓塞的危险因素(比值比分别为3.40、14.87、17.78、2.80、1.88,95%置信区间分别为1.38~8.39、4.34~50.98、4.63~68.22、1.19~6.58、1.47~2.41,P<0.05)。多因素logistic回归分析显示,治疗期间卧床时间>7 d、合并COPD、入院时ABSI评分高均为严重烧伤患者并发肺动脉栓塞的独立危险因素(比值比分别为11.02、30.82、1.86,95%置信区间分别为2.76~43.98、3.55~267.33、1.38~2.50,P<0.05)。根据前述3个独立危险因素构建严�Objective To screen the risk factors for pulmonary embolism in severe burn patients,based on which,a risk prediction model was established and validated.Methods This study was a retrospective case series study.The clinical data of 267 severe burn patients who met the inclusion criteria and were admitted to the Department of Burns of Wuhan Third Hospital from March 2020 to March 2023 were collected,including 159 males and 108 females,aged 18-82 years.The patients were divided into pulmonary embolism group(26 cases)and non-pulmonary embolism group(241 cases)according to whether they were complicated with pulmonary embolism.The following data of patients in the 2 groups were collected and compared,including gender,age,body mass index,bedtime during treatment,cause of burn,albumin level on admission,combination of chronic obstructive pulmonary disease(COPD),combination of diabetes mellitus,combination of hypertension,combination of inhalation injury,and the abbreviated burn severity index(ABSI)on admission.The indicators with statistically significant differences between the two groups were conducted with univariate and multivariate logistic regression analyses to identify the independent risk factors for pulmonary embolism in 267 severe burn patients.Based on these findings,a nomogram prediction model was established.The performance of the prediction model was evaluated by the receiver operating characteristic(ROC)curve,while its validation was conducted through calibration curve and clinical decision curve analysis.Results The proportions of beyond 60 years old,bedtime over 7 days during treatment,combination of COPD,and combination of diabetes mellitus(with χ^(2) values of 7.75,29.15,29.86,and 5.94,respectively),and ABSI score on admission(t=6.01)of patients in pulmonary embolism group were significantly higher than those in non-pulmonary embolism group(P<0.05).There were no statistically significant differences in the other indicators between the two groups of patients(P>0.05).The univariate logistic regression

关 键 词：烧伤 危险因素 列线图 肺动脉栓塞 

分 类 号：R644[医药卫生—外科学] R563.5[医药卫生—临床医学]