摘要
目的探讨泌尿造口渗漏的高危风险因素,并构建预测模型。方法选取2020年1月至2024年12月在某院接受永久性泌尿造口术的186例患者作为研究对象,根据术后3个月内的造口渗漏发生情况,采用32点渗漏量表评分将患者分为低渗漏量表组(≤16分,128例)和高渗漏量表组(≥17分,58例)。采用多因素logistic回归分析影响泌尿造口渗漏的高危风险因素;采用Hosmer-Lemeshow检验验证泌尿造口渗漏风险预测模型的拟合度;采用受试者工作特征(ROC)曲线检验泌尿造口渗漏风险预测模型的预测效果。结果两组患者的术前造口定位、造口自护能力、造口回缩、造口凹陷、造口皮肤黏膜分离、造口周围潮湿相关性皮肤损伤(PMASD)比例比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果表明,造口自护能力、造口回缩、造口凹陷、造口皮肤黏膜分离、PMASD均是发生造口渗漏的独立危险因素(均P<0.05)。Hosmer-Lemeshow检验结果显示,预测模型与实际疗效无差异(P=0.932),模型预测的正确率为0.900。以Youden指数最大值为预测模型的最佳临界值,测得ROC曲线下面积为0.903,Youden指数为0.670,灵敏度为0.773,特异度为0.897。结论该预测模型的预测效能良好,可为临床护理人员对泌尿造口渗漏高危患者采取预防性治疗和护理提供参考。
Objective To explore the high-risk factors of urinary stoma leakage(USL)and construct a predictive model.Methods A total of 186 patients who underwent permanent urinary stoma surgery in a hospital from January 2020 to December 2024 were selected as the research subjects.According to the occurrence of stoma leakage within 3 months after surgery,the patients were divided into the low-leakage scale group(≤16 points,128 cases)and the high-leakage scale group(≥17 points,58 cases)using the 32-Point Leakage Scale.Multivariate logistic regression analysis was used to identify the high-risk factors affecting urinary stoma leakage;the Hosmer-Lemeshow test was applied to verify the goodness-of-fit of the USL risk predictive model;and the receiver operating characteristic(ROC)curve was used to test the predictive effect of the USL risk predictive model.Results Significant differences were observed between the two groups in terms of preoperative stoma localization,stoma self-care ability,stoma retraction,stoma depression,stoma mucocutaneous separation,and peristomal moisture-associated skin damage(PMASD)(all P<0.05).Multivariate logistic regression analysis showed that stoma self-care ability,stoma retraction,stoma depression,stoma mucocutaneous separation,and PMASD were independent risk factors for stoma leakage(all P<0.05).The Hosmer-Lemeshow test indicated no difference between the predictive model and the actual efficacy(P=0.932),with a correct prediction rate of 0.900 for the model.The maximum Youden index was used as the optimal cut-off value of the predictive model.Finally,the area under the curve(AUC)was 0.903,the Youden index was 0.670,the sensitivity was 0.773,and the specificity was 0.897.Conclusions The constructed predictive model has good predictive efficacy,which can provide a reference for clinical nurses to promptly implement preventive treatment and nursing for patients at high risk of urinary stoma leakage.
作者
王敏
杨欢
宋宏玉
刘丽
李菲菲
张丽鹏
Wang Min;Yang Huan;Song Hongyu;Liu Li;Li Feifei;Zhang Lipeng(Department of Urology,Central Theater General Hospital,Wuhan 430070,China)
出处
《国际泌尿系统杂志》
2025年第6期111-115,共5页
International Journal of Urology and Nephrology
关键词
泌尿系疾病
造口术
吻合口瘘
Urologic Diseases
Ostomy
Anastomotic Leak
