儿童阻塞性睡眠呼吸暂停综合征术后出血危险因素分析及Nomogram预测模型构建  

Analysis of risk factors for postoperative bleeding in children with snoring and construction of Nomogram prediction model

作　　者：张文婷 李艳霞 夏冬梅[2] ZHANG Wenting;LI Yanxia;XIA Dongmei(Department of Pentacenter,Hui Ya Hospital of the First Affiliated Hospital,Sun Yat-sen University,Huizhou,Guangdong,516081,China;Department of Special Needs,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong,510062,China)

机构地区：[1]惠州市中大惠亚医院,中山大学附属第一医院惠亚医院五官科,广东惠州516081 [2]中山大学附属第一医院特需三区,广东广州510062

出　　处：《中国耳鼻咽喉头颈外科》2024年第12期796-800,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的分析儿童阻塞性睡眠呼吸暂停综合征(OSAS)术后出血危险因素及列线图(Nomogram)预测模型构建。方法回顾性选取惠州市中大惠亚医院2020年11月~2023年11月收治的503例OSAS患儿,均行腺样体扁桃体切除术,按照7∶3比例将患者随机分为建模组和验证组。建模组患者根据术后有无出血分为出血和非出血组。OSAS术后出血的影响因素采用多因素Logistic回归分析,采用R软件构建列线图模型。绘制受试者工作特征(ROC)曲线评估列线图模型的区分度;临床决策曲线(DCA)评估该模型的临床应用价值。结果38例发生出血,发生率为10.80%(38/352)。多因素Logistic回归分析结果显示,年龄、腺样体扁桃体嵌入程度、抗生素使用、腺样体扁桃体切除情况、饮食配合是OSAS术后出血的危险因素(P<0.05)。建模组ROC的曲线下面积(AUC)为0.973,H-L检验为χ^(2)=7.015,P=0.714。外部验证AUC为0.948,H-L检验为χ^(2)=6.897,P=0.694。DCA曲线可知,概率在0.04~0.97时,评估该Nomogram模型临床使用价值较高。结论年龄、腺样体扁桃体嵌入程度、抗生素使用、腺样体扁桃体切除情况、饮食配合是OSAS术后出血的影响因素,以此构建的Nomogram模型可较好的预测OSAS术后出血的风险。OBJECTIVE To investigate the analysis of risk factors for postoperative haemorrhage and the construction of a Nomogram prediction model for childhood obstructive sleep apnea syndrome(OSAS).METHODS Retrospectively,503 cases of OSAS(all adenoid tonsillectomy)admitted to Huizhou Zhongda Huiya Hospital from November 2020 to November 2023 were selected,and the patients were randomly divided into modelling and validation groups according to the ratio of 7:3.The patients in the modelling group were divided into bleeding and non-bleeding groups according to the presence or absence of postoperative bleeding.Factors affecting postoperative bleeding after OSAS were analysed using multifactorial logistic regression;a column-line diagram model was constructed using R software.ROC curves were plotted to assess the differentiation of the column-line diagram model;clinical decision curve(DCA)was used to assess the clinical application value of the model.RESULTS Bleeding occurred in 38 cases with an incidence rate of 10.80%(38/352).The results of multifactorial logistic regression analysis showed that age,degree of adenoid tonsil embedding,antibiotic use,adenoid tonsil removal,and dietary compatibility were risk factors for postoperative bleeding in OSAS(P<0.05).The AUC of ROC in the modelling group was 0.973,and the H-L test wasχ^(2)=7.015,P=0.714.The AUC of external validation was 0.948,and the H-L test wasχ^(2)=6.897,P=0.694.The DCA curves showed that the probability of 0.04-0.97,which assessed the high value of the clinical use of this Nomogram model.CONCLUSION Age,degree of adenoid tonsil embeddedness,antibiotic use,adenoid tonsil resection,and dietary compatibility are the influencing factors of postoperative bleeding after OSAS,and the Nomogram model constructed in this way can better predict the risk of postoperative bleeding after OSAS.

关 键 词：儿童 睡眠呼吸暂停 阻塞性 手术后出血 危险因素 列线图 

分 类 号：R76[医药卫生—耳鼻咽喉科]