内镜下结肠息肉切除术后迟发性出血风险预警模型构建  

Construction of the early warning model for the risk of delayed bleeding after endoscopic colon polypectomy

作　　者：付艳芳 黄佳 张娟 付艳萍 谢雯艳 FU Yanfang;HUANG Jia;ZHANG Juan;FU Yanping;XIE Wenyan(The First People's Hospital of Fuzhou,Fuzhou 344000,China)

机构地区：[1]江西省抚州市第一人民医院,江西省抚州市344000

出　　处：《护理实践与研究》2025年第2期236-243,共8页Nursing Practice and Research

基　　金：抚州市社会发展指导性科技计划项目(编号:[2022]5号-33)。

摘　　要：目的构建内镜下结直肠息肉切除术后迟发性出血(DPPB)的风险预警模型。方法选取2018年1月—2022年12月抚州市第一人民医院收治的360例行内镜下结直肠息肉切除术患者作为研究对象进行回顾性分析,收集患者的临床资料及相关检查资料,按照7:3比例分为训练集(n=252)和验证集(n=108),其中训练集252例患者按是否发生迟发性出血分为DPPB组和非DPPB组,采用单因素分析、多因素Logistic回归分析确定DPPB的独立危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)验证模型的校准度和区分度,采用R4.2.1软件对筛选出的独立危险因素构建列线图预警模型。结果训练集中252例患者发生DPPB的有16例,发生率为6.39%。分析结果显示,DPPB组和非DPPB组患者合并高血压、息肉数目、息肉大小、切除方式、凝血酶原时间延长比较有意义(P<0.05)。且合并高血压(OR=11.901,95%CI=2.048~69.169)、息肉数目≥2个(OR=8.099,95%CI=1.607~40.821)、切除方式ESD(OR=107.618,95%CI=12.614~918.139)、息肉大小≥1.0 cm(OR=5.692,95%CI=1.302~24.882)和凝血酶时间延长(OR=20.461,95%CI=3.255~128.607)均为DPPB发生的独立危险因素(P<0.05)。训练集ROC曲线AUC为0.945(95%CI:0.895~0.995,P<0.05),最大约登指数为0.790,灵敏度为93.8%,特异度为85.2%,模型拟合度较好(P=0.883);验证集AUC为0.924(95%CI:0.882~0.966,P<0.05),最大约登指数为0.721,灵敏度为89.3%,特异度为84.5%。采用R软件建立预测影响DPPB发生相关因素的列线图模型,列线图风险预警模型区分度好。校准曲线显示模型的预测结果与实际观察到的发生率较一致。结论合并高血压、息肉数目、息肉大小、切除方式、凝血酶原时间延长是结直肠息肉内镜下切除术后迟发性出血的危险因素,临床治疗可以此为参考,采取相应措施为患者进行治疗,从而提高治疗效果。Objective To construct a risk warning model for delayed postoperative bleeding(DPPB)after endoscopic colorectal polypectomy.Methods To select 360 endoscopic colorectal polypectomy patients admitted to the First People's Hospital of Fuzhou from January 2018 to December 2022 as the study subjects for retrospective analysis,clinical data and relevant examination data of the patients were collected and divided into a training set(n=252)and a validation set(n=108)in accordance with the ratio of 7:3,252 patients of the training set were divided into DPPB and non-DPPB groups according to the occurrence of delayed bleeding,the independent risk factors for DPPB were determined by univariate and multifactorial Logistic regression analyses,the calibration and differentiation of the model were verified by the area under the curve(AUC)of the work characteristics of the subjects,and a column chart warning model was constructed by using the software of R4.2.1 for the independent risk factors selected.R4.2.1 software was used to construct a column chart warning model for the screened independent risk factors.Results In the training set,16 of the 252 patients had DPBB,with an incidence rate of 6.39%,The results of the analysis showed that there was a significant comparison between the DPPB and non-DPPB groups in terms of combined hypertension,number of polyps,polyp size,resection method,and prolonged prothrombin time(P<0.05).And the combined hypertension(OR=11.901,95%CI=2.048~69.169),number of polyps≥2(OR=8.099,95%CI=1.607~40.821),resection method ESD(OR=107.618,95%CI=12.614~918.139),polyp size≥1.0 cm(OR=5.692,95%CI=1.302~24.882),polyp size≥1.0 cm(OR=20.461,95%CI=3.255~128.607)and prolonged prothrombin time(OR=20.461,95%CI=3.255~128.607)were the independent risk factors(P<0.05)for the development of DPPB.The ROC curve AUC of the training set was 0.945(95%CI:0.895~0.995,P<0.05),the maximum Jordon index was 0.790,the sensitivity was 93.8%,the specificity was 85.2%,and the modelfit was good(P=0.883);and that of the validat

关 键 词：结直肠息肉 内镜下切除 迟发性出血 风险预警模型 危险因素 

分 类 号：R47[医药卫生—护理学]