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| 先天性膈疝术后远期肺功能预后的影响因素分析及列线图模型构建与验证 |
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| 投稿时间：2025-10-17 修订日期：2026-05-16 |
| DOI： |
| 中文关键词: 先天性膈疝 远期肺功能 影响因素 列线图? |
| 英文关键词: congenital diaphragmatic hernia long-term pulmonary function influencing factors nomogram |
| 基金项目:北京市卫生健康委员会高层次公共卫生技术人才建设项目培养计划(学科骨干-01-034) |
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| 中文摘要: |
| 目的:探讨先天性膈疝(CDH)患儿术后远期肺功能预后的影响因素,构建并验证列线图预测模型,为临床早期识别高危患儿及制定护理干预策略提供依据。方法:回顾性收集2019年1月至2022 年7月于我院接受CDH修补术的92例患儿临床资料,根据3岁时用力呼气容积占预计值百分比(FEV?% pred)将患儿分为预后良好组(FEV?% pred≥80%)(55例)和预后不良组(FEV?% pred<80%)(37例)。采用单因素分析筛选潜在危险因素,将P<0.1的变量纳入多因素Logistic回归分析以确定独立危险因素,基于此构建列线图模型,并通过C指数、校准曲线、ROC曲线及决策曲线评估模型效能。结果:多因素Logistic回归分析显示,疝侧(右侧,OR=2.522,95% CI:1.203~5.287)、术前肺头比(LHR,OR=0.226,95% CI:0.108~0.472)、合并肺动脉高压(OR=2.930,95% CI:1.286~6.671)、膈肌缺损直径(OR=1.728,95% CI:1.145~2.607)、术后机械通气时间(OR=1.031,95% CI:1.008~1.054)及术后氧疗时间≥10 d(OR=2.451,95% CI:1.162~5.171)是CDH术后远期肺功能预后不良的独立危险因素(P均<0.05),敏感性分析结果显示多因素分析结果不受高关联变量干扰。基于上述因素构建的列线图模型 C指数为0.856(95% CI:0.772~0.940),ROC曲线下面积(AUC)为0.755(95% CI:0.674~0.835),校准曲线显示预测概率与实际概率一致性良好(Hosmer-Lemeshow检验P=0.342),决策曲线提示模型在阈值概率10%~80%范围内具有显著临床净获益。结论:右侧膈疝、低术前LHR、合并肺动脉高压等6项指标是CDH术后远期肺功能预后的关键影响因素,基于这些因素构建的列线图模型具有良好的区分度、校准度和临床实用性。临床可依据模型识别高危患儿,针对性实施精细化呼吸护理、感染预防及康复训练等护理干预,以改善患儿远期肺功能及生存质量。 |
| 英文摘要: |
| Objective: To investigate the factors influencing the long-term pulmonary function outcomes of children with congenital diaphragmatic hernia (CDH) following surgery, to construct and validate a nomogram prediction model, and to provide evidence for the early identification of high-risk patients and the development of nursing intervention strategies in clinical practice. Methods: Retrospectively collect clinical data from 92 children who underwent CDH repair surgery at our hospital from January 2019 to July 2022. Based on the percentage of forced expiratory volume at one second (FEV?%) relative to the predicted value at age 3, the children were divided into a good prognosis group (FEV?% pred ≥ 80%) (55 cases) and a poor prognosis group (FEV?% pred < 80%) (37 cases). Univariate analysis was used to screen for potential risk factors, and variables with P<0.1 were included in multivariate logistic regression analysis to identify independent risk factors. Based on this, a nomogram model was constructed, and its performance was evaluated using the C-index, calibration curve, ROC curve, and decision curve. Results: Multivariate logistic regression analysis showed that the side of the hernia (right side, OR=2.522, 95% CI: 1.203–5.287), preoperative lung-head ratio (LHR, OR=0.226, 95% CI: 0.108–0.472), concomitant pulmonary hypertension (OR=2.930, 95% CI: 1.286–6.671), diaphragmatic defect diameter (OR=1.728, 95% CI: 1.145–2.607), Postoperative mechanical ventilation time (OR = 1.031, 95% CI: 1.008–1.054) and postoperative oxygen therapy duration ≥ 10 days (OR = 2.451, 95% CI: 1.162–5.171) were independent risk factors for poor long-term pulmonary function outcomes after CDH surgery (P < 0.05 for all).The results of the sensitivity analysis showed that the outcomes of the multivariate analysis were not interfered with by highly correlated variables. The C-index of the nomogram model constructed based on the above factors was 0.856 (95% CI: 0.772–0.940), with an area under the ROC curve (AUC) of 0.755 (95% CI: 0.674–0.835). The calibration curve showed good agreement between predicted and actual probabilities (Hosmer-Lemeshow test P = 0.342), and the decision curve indicated that the model had significant clinical net benefit within a threshold probability range of 10%–80%. Conclusion: Right diaphragmatic hernia, low preoperative LHR, and pulmonary hypertension are among the six key factors influencing long-term pulmonary function outcomes following CDH surgery. A nomogram model constructed based on these factors demonstrates excellent discriminatory ability, calibration, and clinical utility. Clinicians can use the model to identify high-risk patients and implement targeted nursing interventions, such as personalized respiratory care, infection prevention, and rehabilitation training, to improve long-term lung function and quality of life in these patients. |
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