摘要
目的分析脊柱骨折术后发生腹胀的危险因素,并构建风险Nomgram预警模型。方法回顾性选取2018年1月至2021年8月广州医科大学附属顺德医院骨科收治的318例脊柱骨折患者作为研究对象,根据是否发生腹胀将其分为发生组(n=64)和未发生组(n=254),分析所选患者的临床资料,应用单因素和Logistic回归分析筛选脊柱骨折术后患者发生腹胀的危险因素,根据独立危险因素构建Nomgram预警模型并进行拟合优度检验。结果共纳入318例脊柱骨折患者,经相关检测确认术后发生腹胀有64例,其发生率为20.13%;两组患者临床资料对比显示抗菌药物、肠道菌群药、胃肠动力药、麻醉方式、低蛋白、低钾、术后卧床时间以及每天下床活动次数等资料间差异有统计学意义(P<0.05);Logistic回归分析结果表明,应用抗菌药物(OR=2.509,95%CI:1.321~4.766,P<0.05)、未应用肠道菌群药(OR=0.399,95%CI:0.210~0.760,P<0.05)、未应用胃肠动力药(OR=0.355,95%CI:0.185~0.685,P<0.05)、全身麻醉(OR=2.357,95%CI:1.242~4.473,P<0.05)、低钾(OR=2.471,95%CI:1.299~4.703,P<0.05)、术后卧床时间≥5 d(OR=3.082,95%CI:1.601~5.932,P<0.05)以及每天下床活动次数<3次(OR=0.372,95%CI:0.197~0.703,P<0.05)是脊柱骨折术后发生腹胀的独立危险因素;基于7项独立危险因素构建脊柱骨折术后发生腹胀的风险Nomogram预警模型验证结果显示,C-index为0.808(95%CI:0.778~0.838),校正曲线的预测值与实测值基本一致,内部验证脊柱骨折术后患者发生腹胀风险Nomogram模型的ROC曲线下面积(AUC)为0.802(95%CI:0.775~0.829)。结论应用抗菌药物、未应用肠道菌群药、未应用胃肠动力药、全身麻醉、低钾、术后卧床时间≥5 d、每天下床活动次数<3次是脊柱骨折术后发生腹胀的独立危险因素,基于上述危险因素建立的Nomogram模型可准确评估和量化脊柱骨折术后发生腹胀的风险。
Objective To analyze the influencing factors of postoperative abdominal distension in patients with spinal fracture,and construct a Nomgram risk early warning model.Methods A total of 318 patients with spine fractures from January 2018 to August 2021 were selected.According to whether abdominal distension occurred or not,they were divided into the occurrence group(n=64)and the non-occurring group(n=254),single factor analysis and Logistic regression analysis was used to screen the influencing factors of abdominal distension in patients after spinal fracture,construct a Nomgram risk early warning model based on the independent influencing factors and conduct goodness of fit test.Results 64 cases of abdominal distension occurred after surgery,and the incidence was 20.13%.There were significant differences between the two groups in the antimicrobial drugs,intestinal flora drugs,gastrointestinal motility drugs,anesthesia methods,low protein,low potassium,postoperative bed rest time and daily out-of-bed activities(P<0.05).Logistic regression analysis showed that the use of antibacterial drugs(OR=2.509,95%CI:1.321~4.766,P<0.05),no intestinal flora drugs(OR=0.399,95%CI:0.210~0.760,P<0.05),no gastrointestinal motility drugs(OR=0.355,95%CI:0.185~0.685,P<0.05),general anesthesia(OR=2.357,95%CI:1.242~4.473,P<0.05),hypokalemia(OR=2.471,95%CI:1.299~4.703,P<0.05),postoperative bed rest time≥5 d(OR=3.082,95%CI:1.601~5.932,P<0.05),daily out-of-bed activities<3 times(OR=0.372,95%CI:0.197~0.703,P<0.05)were independent risk factors for postoperative abdominal distension after spinal fracture.The Nomogram warning model for the risk of abdominal distension after spinal fracture constructed based on the 7 independent risk factors showed that the C-index was 0.808(95%CI:0.778~0.838).The predicted value of the curve was basically consistent with the measured value.The area under the ROC curve(AUC)of the Nomogram model for internal verification of the risk of abdominal distension in patients with spinal fractures was 0.802(95%CI:0.775~0.829).Conclusions The use of antibacterial drugs,no intestinal flora drugs,no gastrointestinal motility drugs,general anesthesia,hypokalemia,postoperative bed time≥5 d,daily out-of-bed activities<3 times were the cause of abdominal distension after spinal fracture independent risk factors.The Nomogram model established based on the above risk factors can accurately assess and quantify the risk of patients with abdominal distension after spinal fracture surgery.
作者
黎淑琴
简丽峰
刘碧玉
黄嘉钘
李创
李春雨
崔基浩
LI Shuqin;JIAN Lifeng;LIU Biyu;HUANG Jiaxing;LI Chuang;LI Chunyu;CUI Jihao(Department of Orthopedics,Shunde Hospital Affiliated to Guangzhou Medical University,Foshan 528315,China)
出处
《医药高职教育与现代护理》
2022年第4期359-364,共6页
Medical Higher Vocational Education and Modern Nursing
