外倒转术成功的影响因素和列线图模型构建  

Factors Affecting the Success of External Cephalic Version and Construction of Nomogram Prediction Model

作　　者：李欢喜 陈琼华 陈怡玲[3] LI Huanxi;CHEN Qionghua;CHEN Yiling(Department of Obstetrics and Gynecology,The School of Clinical Medicine,Fujian Medical University,Fuzhou Fujian 350000,China;Department of Obstetrics,Women and Children′s Hospital,School of Medicine,Xiamen University,Xiamen Fujian 361000,China;Department of Obstetrics and Gynecology,The First Affiliated Hospital of Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]福建医科大学临床医学部妇产科,福建福州350000 [2]厦门大学附属妇女儿童医院产科,福建厦门361000 [3]厦门大学附属第一医院妇产科,福建厦门361000

出　　处：《实用妇产科杂志》2025年第1期60-65,共6页Journal of Practical Obstetrics and Gynecology

基　　金：福建省临床医学研究中心(编号:2021Y2019)。

摘　　要：目的:探讨外倒转术(ECV)成功的影响因素,并构建列线图预测模型。方法:收集2018年7月1日至2023年7月31日在厦门大学附属妇女儿童医院产科由固定2名产科医生实施ECV的269例孕妇的临床和影像学资料,选择215例为训练集,54例为验证集。在训练集中,根据ECV结局分为成功组(160例)与失败组(55例),应用多因素Logistic回归分析建立ECV成功率预测模型,绘制列线图并采用决策曲线分析(DCA)、校准曲线和受试者工作特征(ROC)曲线评估模型的性能和准确度并进行验证。结果:269例孕妇实施ECV,总成功率75.46%,经产妇成功率(81.11%)高于初产妇成功率(64.04%),差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:羊水指数(AFI)、胎盘后壁、胎头可触及、胎背侧向、胎先露未入盆是影响ECV成功的独立因素(P<0.05)。使用以上5个因素构建列线图模型预测ECV成功率的曲线下面积(AUC)值为0.906,该模型验证集AUC为0.831。结论:建立基于影响因素预测ECV成功率的列线图模型具有良好的准确度和较高的临床应用价值。Objective:To explore the factors influencing the success of external cephalic version(ECV)and to construct a nomogram prediction model.Methods:The clinical and imaging data of 269 pregnant women who underwent ECV by two obstetricians in the Department of Obstetrics,Women and Children′s Hospital,School of Medicine,Xiamen University,from 1 July 2018 to 31 July 2023 were collected,and 215 cases were selected as the training set and 54 cases as the validation set.According to the ECV outcome,the patients were divided into the success group(160 cases)and the failure group(55 cases)in the training set.A multifactorial Logistic regression analysis was performed to establish an ECV success rate prediction model and draw a nomogram.The performance and accuracy of the model was evaluated and verified using the receiver operating characteristic(ROC)curve,calibration curve and the clinical decision curve(DCA).Results:ECV was performed in 269 pregnant women,with a total success rate of 75.46%,and the success rate of menstruating mothers(81.11%)was higher than that of primigravid women(64.04%),with a statistically significant difference(P<0.05).Multifactorial Logistic regression analysis showed that amniotic fluid index(AFI),placenta position,palpability of the fetal head,direction of the fetal back,and whether the fetal presentation engages the pelvis were independent factors affecting the success of ECV(P<0.05).The above five factors were used to construct a nomogram model with the area under the ROC curve(AUC)was 0.906,and the AUC for the validation set of this model was 0.831.Conclusions:The nomogram model for predicting the success rate of external cephalic version constructed has good accuracy and high clinical application value.

关 键 词：外倒转术 影响因素 列线图 

分 类 号：R719.5[医药卫生—妇产科学]