胸腰椎爆裂骨折伴神经损伤围术期隐性失血的统计学决策树模型分析

Statistical decision tree model analysis on hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency

背景:有研究表明脊柱围术期间具有较高的隐性失血,但是对隐性失血形成的危险因素并未阐述,试验对相关因素进行分析,筛选出高危因素。目的:分析胸腰椎爆裂骨折伴神经损伤围术期隐性失血量及相关因素变化。方法:回顾性分析2016年9月至2019年1月在新疆医科大学第六附属医院接受脊柱手术治疗的85例胸腰椎爆裂骨折伴神经损伤患者临床资料,包括患者的年龄、性别、民族、高血压病、糖尿病、冠心病、吸烟和饮酒史、非酯化脂肪酸(总胆固醇、三酰甘油)、手术时间、手术切口长度、术中晶体液量、术中胶体液量、自体血输注、异体血输注、术后椎体高度恢复率、手术治疗时间窗(<48 h、≥48 h)、伤椎节段及手术固定节段,采用Gross方程计算隐性失血量;以Logistic回归分析发生隐性失血的危险因素。结果与结论:①胸腰椎爆裂骨折伴神经损伤患者85例中男66例,女19例,平均(40.75±12.42)岁,估计总失血量(1030.84±115.45)mL,隐性失血量(484.57±98.38)mL,隐性失血量占理论总失血量的47.05%;②通过单因素、多因素Logistic回归分析结果显示:年龄、三酰甘油>1.63 mmol/L、胆固醇>5.76 mmol/L、手术切口延长、手术时间窗<48 h及合并吸烟史是围术期间隐性失血阳性发生的独立危险因素(P<0.05);③通过SPSS 24.0统计学决策树模型分析及ROC曲线下面积验证显示,年龄>48岁时,该模型敏感性76.0%,特异性88.4%,具有一定的诊断准确性;④上述结论证实,隐性失血在脊柱手术围术期占有较高的比例,而年龄>48岁、胆固醇及三酰甘油偏高、手术切口延长、手术时间窗<48 h、合并吸烟史是隐性失血阳性发生的高危因素。

BACKGROUND:Some studies have shown that there is a high rate of hidden blood loss during spinal surgery,but the risk factors of hidden blood loss have not been described.In this study,the related factors were analyzed and the high risk factors were screened out.OBJECTIVE:To analyze the relevant factors of hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency.METHODS:The clinical data of 85 patients with thoracolumbar burst fracture and neurological deficiency received spinal surgery treatment in Sixth Affiliated Hospital of Xinjiang Medical University from September 2016 to January 2019 were analyzed.The patients’data including age,gender,ethnic group,hypertension,diabetes,coronary heart disease,history of smoking and drinking,free fatty acid(total cholesterol,triglyceride),operation time,length of surgical incision,the amount of crystalloid solution during operation,the amount of colloidal solution during operation,autologuous blood injection,homologous blood transfusion,postoperative recovery rate of vertebral height,time window of surgical treatment(<48 hours,≥48 hours),the segment of fractured vertebra and the segment of operative fixation were recorded.Gross was adopted to calculate the volume of hidden blood loss.Logistic regression analysis was used to further discuss risk factors for hidden blood loss.RESULTS AND CONCLUSION:(1)There were 66 males and 19 females with an average age of(40.75±12.42)years in the total 85 cases of the patients with thoracolumbar burst fracture and neurological deficiency.The estimated total blood loss volume was(1030.84±115.45)mL.The volume of hidden blood loss was(484.57±98.38)mL.The volume of hidden blood loss accounted for 47.05%of the total blood loss volume in theory.(2)The results of single-factor and multivariate Logistic regression analysis showed that age,triglyceride>1.63 mmol/L and cholesterol>5.76 mmol/L,extended surgical incision and surgical time window<48 hours,and smoking history were the independent risk factors for positive hidden blood loss during the perioperative period(P<0.05).(3)The decision tree model analysis of SPSS 24.0 and ROC area under the curve verified that when the age was>48 years,sensibility and specificity were 76.0%and 88.4%respectively,with a certain diagnostic accuracy.(4)It is concluded that hidden blood loss accounts for a high proportion in the perioperative period of the spine.Age>48 years,slightly-high cholesterol and triglyceride,extended surgical incision,surgical time window<48 hours,and combined with smoking history turn out to be the high risk factors for positive hidden blood loss.