摘要
目的分析妇科腹部手术合并下肢深静脉血栓(DVT)的危险因素,并构建风险Nomogram预警模型。方法回顾性选取我院普妇科2017年1月至2021年8月的515例行妇科腹部手术患者作为研究对象,根据是否合并下肢DVT将其分为合并下肢DVT组(n=48)和未合并下肢DVT组(n=467),分析所选患者的临床资料,应用单因素和多因素Logistic回归分析筛选妇科腹部手术合并下肢DVT的危险因素,根据独立危险因素构建风险Nomogram预警模型并进行预测效能验证。结果该研究共纳入515例妇科腹部手术患者,经Doppler超声检查发现有48例患者合并下肢DVT,发生率为9.32%;两组患者临床资料对比显示年龄、BMI、糖尿病、高血压、手术时间、恶性肿瘤、凝血指标、术中气腹压和血浆D-二聚体等资料间差异有统计学意义(p<0.05);Logistic回归分析结果表明,年龄≥60岁(OR=2.747,95%CI:1.357~5.563,p<0.005)、BMI>28kg/m^(2)(OR=2.929,95%CI:1.497~5.733,p<0.002)、糖尿病(OR=2.433,95%CI:1.251~4.731,p<0.009)、高血压(OR=2.787,95%CI:1.410~5.506,p<0.003)、手术时间≥3h(OR=2.219,95%CI:1.124~4.379,p<0.022)、凝血指标异常(OR=2.319,95%CI:1.180~4.555,p<0.015)、术中气腹压≥10mmHg(OR=2.550,95%CI:1.300~5.001,p<0.006)以及血浆D-二聚体≥500ng/ml(OR=3.779,95%CI:1.870~7.639,p<0.000)是妇科腹部手术患者合并下肢DVT的独立危险因素;基于8项独立危险因素建立妇科腹部手术患者合并下肢DVT的风险Nomogram预警模型结果显示,年龄≥60岁为76分、BMI>28kg/m^(2)为81分,糖尿病为68分、高血压为77分、手术时间≥3h为62分、凝血指标异常为65分、术中气腹压≥10mmHg为72分和血浆D-二聚体≥500ng/ml为100分,模型验证结果显示C-index为0.838(95%CI:0.810-0.866),校正曲线的预测值与实测值基本一致,内部验证妇科腹部手术患者合并下肢DVT的风险列线图模型的ROC曲线下面积(AUC)为0.827(95%CI:0.796~0.858)。结论年龄≥60岁、BMI>28kg/m^(2)、糖尿病、高血压、手术时间≥3h、凝血指标异常、术中气腹压≥10mmHg以及血浆D-二聚体≥500ng/ml是妇科腹部手术患者合并下肢DVT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妇科腹部手术患者合并下肢DVT的风险。
Objective To analyze the risk factors of gynecological abdominal surgery complicated with deep vein thrombosis(DVT)of the lower extremities,and construct a risk Nomogram early warning model.Method A retrospective selection of 515 patients who underwent gynecological abdominal surgery in the Department of General Gynecology in our hospital from January 2017 to August 2021 were selected as the research objects.According to whether they were combined with lower extremity DVT,they were divided into combined lower extremity DVT group(n=48)and non-combined lower extremity DVT group(n=48).By analyzing the clinical data of selected patients,applying single factor and multivariate logistic regression analysis to screen the risk factors of gynecological abdominal surgery combined with lower extremity DVT,we could construct a risk Nomogram early warning model based on independent risk factors and make predictions performance verification.Result A total of 515 patients undergoing gynecological abdominal surgery were enrolled in this study.Doppler ultrasonography revealed that 48 patients had lower extremity DVT,with an incidence rate of 9.32%.A comparison of clinical data between the two groups showed age,BMI,diabetes,hypertension,and operation time.There were statistically significant differences in data such as,malignant tumors,coagulation indicators,intraoperative pneumoperitoneum pressure and plasma D-dimer(p<0.05);the logistic regression analysis showed that age≥60 years old(OR=2.747,95%CI:1.357~5.563,p<0.005),BMI>28kg/m2(OR=2.929,95%CI:1.497~5.733,p<0.002),diabetes(OR=2.433,95%CI:1.251~4.731,p<0.009),hypertension(OR=2.787,95%CI:1.410~5.506,p<0.003),operation time≥3h(OR=2.219,95%CI:1.124~4.379,p<0.022),abnormal coagulation index(OR=2.319,95%CI:1.180~4.555,p<0.015),intraoperative pneumoperitoneum pressure≥10mmHg(OR=2.550,95%CI:1.300~5.001,p<0.006)and plasma D-dimer≥500ng/ml(OR=3.779,95%CI:1.870~7.639,p<0.000)is an independent risk factor for lower extremity DVT in gynecological abdominal surgery patients;based on 8 independent risk factors to establish a Nomogram warning model for the risk of gynecological abdominal surgery patients with lower extremity DVT The results showed that 76 points for age≥60 years,81 points for BMI>28kg/m2,68 points for diabetes,77 points for hypertension,62 points for operation time≥3h,65 points for abnormal coagulation indexes,and intraoperative pneumoperitoneum The pressure≥10mmHg is 72 points and the plasma D-dimer≥500ng/ml is 100 points.The model verification results show that the C-index is 0.838(95%CI:0.810-0.866),and the predicted value of the calibration curve is basically consistent with the measured value.,Internally verified that the area under the ROC curve(AUC)of the risk nomogram model for gynecological abdominal surgery patients with lower extremity DVT is 0.827(95%CI:0.796-0.858).Conclusion Age≥60 years,BMI>28kg/m2,diabetes,hypertension,operation time≥3h,abnormal coagulation index,intraoperative pneumoperitoneum pressure≥10mmHg,and plasma D-dimer≥500ng/ml are gynecological abdominal surgery patients with the independent risk factors of lower extremity DVT,the Nomogram model established based on the above risk factors can accurately assess and quantify the risk of lower extremity DVT in patients with gynecological abdominal surgery.
作者
陈远秀
郭清华
何静玲
CHEN Yuanxiu;GUO Qinghua;HE Jingling(Department of Gynecology,Guangdong provincial Hospital of Traditional Chinese Medicine,Guangzhou,Guangdong 510120,China)
出处
《九江学院学报(自然科学版)》
2025年第1期102-109,共8页
Journal of Jiujiang University:Natural Science Edition
关键词
妇科腹部手术
下肢深静脉血栓
危险因素
预测
Nomogram模型
gynecological abdominal surgery
deep vein thrombosis of lower extremities
risk factors
prediction
nomogram model
