老年急性嵌顿性腹股沟疝合并肠梗阻的危险因素分析及风险列线图模型的建立

Analysis of the risk factors of intestinal obstruction in elderly patients with acute incarcerated inguinal hernia and the establishment of a risk map model

目的探讨老年急性嵌顿性腹股沟疝合并肠梗阻(POI)的危险因素及风险列线图模型的建立,为临床护理工作提供参考依据。方法回顾性分析2012年6月至2018年6月因急性嵌顿性腹股沟疝于我院就诊的259例老年患者的临床资料。按照是否并发POI,分为并发POI组和非POI组。分别使用单因素和Logistic回归多因素分析老年急性嵌顿性腹股沟疝合并发肠梗阻的独立危险因素。然后纳入筛选出的独立危险因素建立列线图预测模型,并对模型的预测性及准确度进行验证。结果2组患者性别、文化程度、身体质量指数、高血脂、高血压、冠心病、吸烟史、酗酒史、术前贫血和手术时间等信息的比较,均无统计学差异(χ^2=0.239,0.324,0.179,0.485,0.282,0.069,0.402,0.146,0.108,0.994;P>0.05),而年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染等资料差异有统计学意义(χ^2=5.963,9.954,17.644,17.281,9.154,8.831;P<0.05)。以并发POI情况为因变量,以并发POI组和非POI组单因素分析中有统计学意义的6个项目(年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间、术后感染)为自变量,进行多元Logistic回归分析,结果表明,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间及术后感染是老年急性嵌顿性腹股沟疝并发POI的独立危险因素,具有统计学差异(OR=3.515,4.506,8.805,17.526,3.937,2.770,0.015;95%CI:1.437~8.601,1.519~13.372,2.349~33.011,3.986~77.067,1.615~9.598,1.147~6.686;P<0.05),均与老年急性嵌顿性腹股沟疝并发POI高度相关。基于年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染这6项老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,建立预测老年急性嵌顿性腹股沟疝并发肠梗阻的列线图模型,经验证,其预测值同实测值基本一致,说明本研究的列线图预测模型具有较好的预测能力,同时本研究该列线图模型使用Bootstrap进行内部验证法,C-index指数高达0.846(95%CI:0.812~0.880),模型对于老年急性嵌顿性腹股沟疝并发POI诊断的ROC也高达0.846,说明本研究列线图模型具有良好的精准度和区分度。结论老年急性嵌顿性腹股沟疝并发肠梗阻的风险较高,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染是老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,相关列线图预测模型的建立能够提高对老年急性嵌顿性腹股沟疝并发肠梗阻的诊断效能,为进一步优化护理模式提供方向,临床应用价值较高,值得进一步推广使用。

Objective To explore the risk factors of intestinal obstruction in elderly patients with acute incarcerated inguinal hernia and the establishment of a risk alignment chart model to provide a reference for clinical nursing work.Methods A retrospective analysis of clinical data of 259 elderly patients aged 60 years or older who were treated in Beijing Tongren hospital for acute incarcerated inguinal hernia from June 2012 to June 2018.According to whether complicated with intestinal obstruction,the patients were divided into intestinal obstruction group and non-intestinal obstruction group.Univariate and Logistic regression multivariate analysis were used to analyze the independent risk factors for intestinal obstruction in elderly patients with acute incarcerated inguinal hernia.Then,the selected independent risk factors were incorporated to establish a nomogram prediction model,and the predictability and accuracy of the model were verified.Results Logistic regression analysis of clinical data of two groups of patients showed that age(OR=3.515,95%CI:1.437-8.601),diabetes(OR=4.506,95%CI:1.519-13.372),and malignant tumors(OR=8.805,95%CI:2.349-33.011),history of abdominal surgery(OR=17.526,95%CI:3.986-77.067),incarceration time(OR=3.937,95%CI:1.615-9.598),and postoperative infection(OR=2.770,95%CI:1.147-6.686)were independent risk factors for intestinal obstruction in elderly patients with acute incarcerated inguinal hernia,with a statistically significant difference(P<0.05).Based on six independent risk factors(age,diabetes,malignant tumors,history of abdominal surgery,incarceration time,and postoperative infection)for intestinal obstruction in elderly patients with acute incarcerated inguinal hernia,a nomogram model for the prediction of intestinal obstruction in elderly patients with acute incarcerated inguinal hernia was established.After verification,the predicted value was basically same as the measured value,which indicated that the nomogram model of this study had a good prediction ability.At the same time,this study uses Bootstrap internal verification method for the collinear model.The graph model is verified.The C-index is as high as 0.846(95%CI:0.812-0.880).The ROC of the model for the diagnosis of elderly acute incarcerated inguinal hernia complicated by intestinal obstruction was also as high as 0.846,indicating that the nomogram model of this study had good accuracy and discrimination.Conclusion Elderly patients with acute incarcerated inguinal hernia have a higher risk of intestinal obstruction.Age,diabetes,malignancy,history of abdominal surgery,incarceration time,and postoperative infection are independent risk factors for intestinal obstruction in elderly patients with acute incarcerated inguinal hernia.The establishment of predictive models of risk factors and related nomograms can improve the diagnostic efficacy of intestinal obstruction in elderly patients with acute incarcerated inguinal hernia,and provide a direction for further optimization of the nursing model.It has high clinical application value and is worth further promotion.