全髋关节置换术患者术后输血的列线图风险预测模型的构建  

Construction of a nomogram-based risk prediction model for postoperative blood transfusion in patients undergoing total hip arthroplasty

作　　者：田烨[1] 张磊[1] 刘志奎[1] 张楠[2] TIAN Ye;ZHANG Lei;LIU Zhikui;ZHANG Nan(Ward 2 of Orthopedics Department,Kailuan General Hospital,Kailuan 063000,China;Ward 1 of Orthopedics Department,Kailuan General Hospital,Kailuan 063000,China)

机构地区：[1]开滦总医院骨科二病区,河北开滦063000 [2]开滦总医院骨科一病区,河北开滦063000

出　　处：《长春中医药大学学报》2025年第3期318-322,共5页Journal of Changchun University of Chinese Medicine

基　　金：河北省2024年度医学科学研究课题计划(20241449)。

摘　　要：目的 探索全髋关节置换术(THA)患者术后输血的影响因素,并构建列线图风险预测模型。方法 回顾性分析2022年1月—2024年6月在开滦总医院骨科住院的360例接受THA患者的临床资料。将数据集按照7:3随机分为训练集(252例)和测试集(108例)。对训练集病例资料进行单因素和多因素Logistic回归分析,筛选出THA患者术后输血的独立影响因素,采用R软件制作列线图,用测试集中样本进行验证,模型区分度评估采用一致性指数(C-index),校准度评估采用校准图。结果 360例THA患者术后输血78例(21.7%),单因素及多因素Logistic回归分析结果显示合并高血压、血红蛋白水平、术中出血量和术后24 h血钙是THA患者术后输血的最佳预测因子。预测模型的C-index为0.818,特异度和灵敏度分别为78.1%和78.2%。外部验证的C-index为0.803,校准图中偏差校正曲线与理想曲线重合度较高,模型校准度较好。结论 本研究构建的THA患者术后输血列线图风险预测模型区分度与校准度较好,可为临床评估术后输血风险、制定个性化治疗方案和提高手术的安全性提供参考。Objective To explore the influencing factors of postoperative blood transfusion in patients undergoing total hip arthroplasty(THA)and to construct a nomogram-based risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 360 THA patients admitted to the Department of Orthopedics in Kailuan General Hospital from January 2022 to June 2024.The dataset was randomly divided into a training set(252 cases)and a test set(108 cases)according to a ratio of 7:3.Univariate and multivariate logistic regression analysis on the training set case data to screen for independent influencing factors of postoperative blood transfusion in THA patients were performed.A nomogram was created using R software,and the model was validated with the test set samples.The model's discrimination was evaluated using the concordance index(C-index),and calibration was assessed using a calibration plot.Results Out of 360 THA patients,78(21.7%)received postoperative blood transfusions.Univariate and multivariate logistic regression analysis showed that comorbidity with hypertension,hemoglobin levels,intraoperative blood loss,and 24-hour postoperative blood calcium were the best predictive factors for postoperative blood transfusions in THA patients.The C-index of the prediction model was 0.818,with specificity and sensitivity of 78.1%and 78.2%,respectively.C-index verified externally was 0.803,and the deviation correction curve in the calibration plot had a high degree of overlap with the ideal curve,indicating good model calibration.Conclusion The risk prediction model for postoperative blood transfusion in THA patients constructed in this study has good discrimination and calibration,which can provide reference for clinical assessment of postoperative blood transfusion risk,development of personalized treatment plans,and improvement of surgical safety.

关 键 词：全髋关节置换术 输血 影响因素 预测模型 

分 类 号：R687.1[医药卫生—骨科学]