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| 心脏外科术后肺部并发症发生风险的列线图预测模型构建 |
| Construction of a nomogram prediction model for risk of pulmonary complications after cardiac surgery |
| 投稿时间：2021-11-16 |
| DOI：10.3969/j.issn.1000-0399.2022.09.005 |
| 中文关键词: 心脏手术 肺部并发症 列线图模型 |
| 英文关键词: Cardiac surgery Pulmonary complications Nomogram model |
| 基金项目:2020年度河南省医学科技攻关计划项目(项目编号:LHGJ20200733) |
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| 中文摘要: |
| 目的 构建预测心脏外科手术患者术后发生肺部并发症的列线图模型,并评估模型的区分度和一致性。方法 选取2016年1月至2021年3月郑州市第七人民医院收治的择期进行心脏瓣膜手术患者517例为研究对象,根据术后是否发生肺部并发症将患者分为肺部并发症组(n=88)和无肺部并发症组(n=429)。收集两组患者的临床资料,采用单因素及多因素logistic回归分析筛选影响心脏外科手术患者术后发生肺部并发症的危险因素;采用R软件构建预测心脏外科手术患者术后发生肺部并发症的列线图模型,并使用受试者工作特征(ROC)曲线及校准曲线验证列线图模型的区分度和一致性。结果 517例心脏外科术后患者肺部并发症发生88例,并发症发生率为17.02%(88/517)。肺部并发症组年龄、吸烟史比例、慢性阻塞性肺部疾病(COPD)比例、术后清蛋白＜35 g/L比例、术后清蛋白水平、术后白细胞计数≥10×109/L比例、术后白细胞计数水平、术中体外循环时间、主动脉阻断时间、术后机械通气时间与无肺部并发症组患者比较,差异有统计学意义(P＜0.05)。多因素logistic回归分析显示,年龄、术后清蛋白、主动脉阻断时间、术后机械通气时间是影响心脏外科手术患者术后发生肺部并发症的危险因素(P＜0.05)。采用R软件构建的列线图预测模型具有较好的区分度(ROC曲线下面积为0.942)与一致性(Hosmer-Lemeshow拟合优度检验χ2=9.443,P=0.336)。结论 基于心脏外科手术患者术后发生肺部并发症的危险因素建立的列线图模型具有良好的预测能力,可个体化预测肺部并发症发生风险。 |
| 英文摘要: |
| Objective To construct a nomogram model for predicting the occurrence of pulmonary complications in patients undergoing cardiac surgery, and to evaluate the distinction and consistency of the model. Methods A total of 517 patients undergoing elective heart valve surgery admitted to Zhengzhou Seventh People’s Hospital from January 2016 to March 2021 were selected as the research objects. All patients were divided into pulmonary complications group (88 cases) and the non-pulmonary complications group (429 cases) according to whether they had pulmonary complications after surgery. The clinical data of patients were collected, univariate and multivariate logistic regression analysis were used to screen the risk factors affecting the occurrence of pulmonary complications in patients undergoing cardiac surgery. R software was used to construct a nomogram model for predicting the occurrence of pulmonary complications after cardiac surgery, and ROC curve and calibration curve were used to verify the discrimination and consistency of the nomogram model. Results In this study 88 cases of pulmonary complications occurred in 517 patients after cardiac surgery, the incidence rate was 17.02% (88/517). There was a statistically significant difference in age, smoking history ratio, chronic obstructive pulmonary disease (COPD) ratio, postoperative albumin <35 g/L ratio, the level of postoperative albumin, postoperative white blood cell count ≥10×109/L ratio, the level of postoperative white blood cell count, intraoperative extracorporeal circulation time, aortic occlusion time, postoperative mechanical ventilation time between the pulmonary complications group and non-pulmonary complications group (P<0.05). Multivariate logistic regression analysis showed that age, postoperative albumin, aortic occlusion time and postoperative mechanical ventilation time were the risk factors of postoperative pulmonary complications in cardiac surgery patients (P<0.05). The nomogram prediction model constructed by R software had good degree of discrimination (the area under the ROC curve was 0.942) and consistency (Hosmer-Lemeshow goodness of fit test χ2=9.443, P=0.336). Conclusion The nomogram model established in this study based on the risk factors of postoperative pulmonary complications in patients with cardiac surgery has good predictive ability,which can individually predict the risk of postoperative pulmonary complications. |
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