胃癌根治术后延迟性肠麻痹发生风险的简易预测评分系统构建与初步验证

doi:10.3969/j.issn.1005-6483.2020.07.016

摘要/Abstract

摘要： 目的构建一项胃癌根治术后延迟性肠麻痹（PPOI）发生风险的简易预测评分系统，并对其预测效能进行初步验证。
方法 2016年10月～2018年3月我院普外科收治的行胃癌根治术病人296例。根据是否发生PPOI，将病人分为PPOI组与非PPOI组，分析可能的危险因素。根据相关危险因素权重，构建风险评分系统并进行验证。
结果 296例病人中，出现PPOI 92例，发生率为31.1%。年龄≥65岁、手术持续时间≥4小时、手术方式为开腹或中转开腹、TNM分期=Ⅲ、术后总阿片类药物使用量（TOP）≥0.3mg/kg是影响病人PPOI发生的独立性危险因素（P＜0.05）。以回归系数=1.5及2.5为界值进行赋值，年龄≥65岁、手术持续时间≥4小时、手术方式为开腹或中转开腹、TNM分期=Ⅲ、TOP≥0.3mg/Kg分别被赋值1.5分、1.0分、1.5分、1.5分、2.5分。赋值后风险评分系统的总分为8分。根据得分不同，分为低风险组、中等风险组、高风险组。低风险组、中等风险组、高风险组的PPOI发生率分别为10.4%、26.8%、72.5%。利用ROC曲线检验预测效能，ROC曲线下面积为0.731，灵敏度为0.74，特异度为0.62，Hosmer-Lemeshow拟合优度检验，χ²=1.526，P=0.93。模型拟合效度好，预测价值高。
结论多种危险因素共同参与了PPOI的发生过程，构建的预测模型有较好的评估效能。

关键词: 延迟性肠麻痹, 胃肿瘤, 危险因素, 受试者工作曲线

Abstract: Objective To construct a simple scoring system for predicting the risk of PPOI，and to preliminarily validate its predictive effectiveness.
Methods A total of 296 patients with gastric cancer were collected.Patients were divided into PPOI group and non PPOI group and the possible risk factors were analyzed.According to the weight of related risk factors，a risk scoring system was constructed and verified.
Results Of the 296 patients，92 cases developed PPOI，the incidence was 31.1%.Multivariable analysis showed that age more than 65 years old，operation duration more than 4h，operation mode of laparotomy，TNM staging=Ⅲ and TOP>0.3mg/Kg were independent risk factors of PPOI（P<0.05）.Assigning values with regression coefficients=1.5 and 2.5，each risk factor was assigned 1.5 points，1.0 points，1.5 points，1.5 points and 2.5 points，respectively.The total score of the scoring system was 8.According to different scores，they were divided into low risk group（0～3 points），medium risk group（4～6 points）and high risk group（7～8 points）.Taking the patient data into the established scoring system，the incidence of PPOI in the low，middle and high risk group were 10.4%，26.8% and 72.5%，respectively.The area under the ROC curve is 0.731，the sensitivity and specificity were 0.74 and 0.62，χ²=1.526，P=0.93.The model has good fitting validity and high prediction value.
Conclusion A variety of risk factors are involved in the occurrence of PPOI.The prediction model has a good evaluation efficiency and has certain clinical application value.

Key words: delayed intestinal paralysis, gastric neoplasms, risk factors, receiver operating curve

毛兴波魏一儒庄丽萍邬长康. 胃癌根治术后延迟性肠麻痹发生风险的简易预测评分系统构建与初步验证[J]. 临床外科杂志, 2020, 28(7): 654-657.

MAO Xingbo, WEI Yiru, ZHUANG Liping, et al.. Establishment and preliminary validation of a predictive scoring system for risk of PPOI after radical gastrectomy for gastric cancer[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(7): 654-657.

参考文献

相关文章 15

[1]	甄庆强, 陈克军, 赵志强等. 影响糖尿病下肢溃疡愈合的危险因素分析[J]. 临床外科杂志, 2020, 28(6): 518-821.
[2]	李静, 孙冬弢. 重度颅脑损伤病人颅内血肿清除术后急性肾功能不全的危险因素分析[J]. 临床外科杂志, 2020, 28(6): 581-583.
[3]	吕学文, 张小雷, 谢利娜, 杨红秀. 重症颅脑损伤病人气管切开术后继发肺部真菌感染的危险因素分析[J]. 临床外科杂志, 2019, 27(8): 700-702.
[4]	陈泽洋, 刘玉村, 王鹏远. 非幽门螺杆菌与胃癌关系的研究进展[J]. 临床外科杂志, 2019, 27(8): 724-727.
[5]	陈沛锐, 卿秋杉, 车国卫等. 术前胸中上段食管癌颈部淋巴结转移相关因素分析[J]. 临床外科杂志, 2019, 27(7): 566-569.
[6]	陶凯雄. 腹腔镜胃癌根治术并发症的防治策略[J]. 临床外科杂志, 2019, 27(5): 363-366.
[7]	蔡开琳. 胃癌诊疗相关的临床病理学进展对外科的影响[J]. 临床外科杂志, 2019, 27(5): 370-372.
[8]	李欣龙, 顾立虎, 祝和攀, 潘军海, 陈玉萍. 加速康复外科理念在腹腔镜胃癌根治术中的应用[J]. 临床外科杂志, 2019, 27(5): 404-407.
[9]	文妍, 黄家辉, 陆瑶瑶, 马朝群, 张传灼. 乳腺癌术后伴原发甲状腺癌17例[J]. 临床外科杂志, 2019, 27(3): 212-213.
[10]	邓乐章, 周益, 许勇. 髋关节置换术后股骨假体周围骨折危险因素分析[J]. 临床外科杂志, 2019, 27(2): 163-165.
[11]	王鹏, 席树强. 腹腔镜下胆囊切除术后并发肠粘连的危险因素分析[J]. 临床外科杂志, 2019, 27(12): 1024-1027.
[12]	闫瑞承, 李士军, 王旭峰, 罗建飞. 腹腔镜下右半结肠癌根治术后胃肠功能障碍的高危因素分析及预测模型的建立[J]. 临床外科杂志, 2019, 27(11): 957-959.
[13]	王磊, 颜登国. 老年结直肠癌病人围手术期手术危险因素分析[J]. 临床外科杂志, 2019, 27(11): 999-1001.
[14]	黄侃刘松陈宝俊. 食管癌根治术后吻合口漏的危险因素分析[J]. 临床外科杂志, 2018, 26(9): 671-673.
[15]	曾锦威江永发. 评估分析老年骨科病人手术后不良结果的相关风险因素[J]. 临床外科杂志, 2018, 26(11): 880-882.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed