消化性溃疡穿孔病人术后死亡危险因素分析及列线图模型构建  

Risk factors analysis of postoperative mortality in patients with peptic ulcer perforation and construction of a nomogram

作　　者：沈剑涛 王西刚 凌新建 马军[1] 张亚铭[1] Shen Jiantao;Wang Xigang;Ling Xinjian;Ma Jun;Zhang Yaming(Department of General Surgery,Anqing Municipal Hospital,Anhui Anqing 246003,China)

机构地区：[1]安庆市立医院普外科,安徽安庆246003

出　　处：《腹部外科》2025年第2期128-133,共6页Journal of Abdominal Surgery

基　　金：2023年度安徽省科研编制计划重点项目(2023AH050577)。

摘　　要：目的分析消化性溃疡穿孔(peptic ulcer perforation,PPU)病人术后死亡危险因素,构建PPU病人术后死亡列线图预测模型并对其进行评估验证。方法采用病例对照研究的方法,回顾性分析2019年1月至2023年12月在安庆市立医院普外科手术治疗的PPU病人资料,收集病人一般情况和入院后生化检验等21个指标。根据术后结局是否为死亡,先进行单因素分析,后将单因素分析中有统计学差异的指标进行多因素logistic回归分析。基于多因素结果构建死亡结局的列线图预测模型,采用Bootstrap法重复抽样完成内部验证,受试者操作特征曲线、校准曲线、临床决策曲线分析评估模型。结果共入组病例283例,根据术后结局是否死亡分为术后死亡组(n=27)和存活组(n=256),死亡率为9.5%。PPU病人术后死亡组和存活组的性别、年龄、术前是否合并休克、发病至手术时间是否超过24 h、高血压病史、脑血管后遗症、心脏病史、慢性阻塞性肺疾病病史、服用免疫抑制剂、白细胞计数、血红蛋白、白蛋白、血肌酐、C反应蛋白比较,差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄增加(OR=1.080,95%CI:1.006~1.160)、发病至手术时间>24 h(OR=7.122,95%CI:1.361~37.280)、术前合并慢性阻塞性肺疾病(OR=27.017,95%CI:2.172~336.106)、血肌酐升高(OR=1.016,95%CI:1.008~1.020)是PPU病人术后死亡的危险因素,白细胞计数升高(OR=0.859,95%CI:0.761~0.969)是保护因素。基于多因素结果构建的列线图预测模型,内部验证受试者操作特征曲线下面积为0.963(95%CI:0.934~0.986),校准曲线与理想曲线接近,临床决策曲线分析显示预测模型有明显的正向净效益。结论根据年龄、发病至手术时间>24 h、合并慢性阻塞性肺疾病、白细胞计数、血肌酐5个指标构建的PPU病人术后死亡列线图预测模型具有良好的预测能力,可以早期筛查高风险PPU手术病人,有助于改善PPObjective To analyze the risk factors for postoperative mortality in patients with perforated peptic ulcer(PPU),and to develop a nomogram to predict the postoperative mortality in PPU patients and to evaluate its performance.Methods A case-control study was conducted.Clinical data of PPU patients who underwent surgical treatment in the Department of General Surgery at Anqing Municipal Hospital from January 2019 to December 2023 were retrospectively analyzed.A total of 21 indicators,including general information and biochemical tests on admission,were collected.A univariate analysis was first performed to assess whether postoperative outcomes resulted in the mortality,followed by a multivariate logistic regression analysis of statistically significant indicators from the univariate analysis.Based on the results of the multivariate analysis,a nomogram to predict the mortality in postoperative PPU patients was constructed.Internal validation was performed using the Bootstrap resampling method.The performance of the nomogram was evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results A total of 283 patients were enrolled in the study and divided into the postoperative death group(n=27)and survival group(n=256)based on postoperative outcomes,with a mortality rate of 9.5%.Statistically significant differences were observed between the postoperative death group and the survival group in terms of gender,age,presence of shock before surgery,time from onset to surgery being greater than 24 hours,history of hypertension,cerebrovascular sequelae,history of heart disease,history of chronic obstructive pulmonary disease(COPD),use of immunosuppressants,white blood cell count,hemoglobin,albumin,creatinine,and C-reactive protein(P<0.05).The multivariate logistic regression analysis showed that older age(OR=1.080,95%CI:1.006-1.160),time from onset to surgery being greater than 24 hours(OR=7.122,95%CI:1.361-37.280),history of COPD(OR=27.017,95%CI:2.172-336.106),and

关 键 词：消化性溃疡穿孔 死亡 危险因素 列线图 

分 类 号：R656.6[医药卫生—外科学]