先天性肠闭锁术后患儿肠功能障碍危险因素分析

Analysis of risk factors of intestinal dysfunction in children after congenital atresia

目的了解先天性肠闭锁(congenital intestinal atresia,CIA)术后患儿肠功能障碍的危险因素,初步建立CIA患儿术后肠功能障碍预测模型。方法采用便利抽样方法,选择2017年6月至2020年6月在广东省某三甲专科医院新生儿外科住院的CIA患儿367例,根据肠功能障碍判断标准,将367例患儿分为肠功能障碍组192例(占52.3%)和非肠功能障碍组175例(占47.7%),对两组的资料进行单因素分析,将有统计学意义的因素进行Logistic回归分析,初步建立预测模型,并分析该模型的预测效果。结果出生体重、闭锁类型、术后恢复经口喂养时间为影响CIA患儿术后肠功能恢复的独立预测因子(P<0.05),最终建立的预测模型受试者操作特征曲线下面积为0.781(95%CI为0.727~0.835,P<0.001),Hosmer-Lemeshow检验结果显示,χ^2=7.181,P=0.517。结论CIA术后患儿肠功能障碍发生率较高。出生体重、闭锁类型、术后恢复经口喂养时间是影响CIA术后肠功能障碍的独立危险因素。本研究构建的预测模型能较好地预测CIA术后患儿肠功能障碍发生的风险,可为医护人员实施相应的管理措施提供参考。

Objective To investigate the risk factors of intestinal dysfunction in children with congenital intestinal atresia(CIA),and establish a preliminary prediction model for intestinal dysfunction in children with CIA.Methods A retrospective cohort study method was used to collect children diagnosed with CIA in the neonatal surgery of a tertiary hospital in Guangdong Province from January 2017 to June 2020.According to the standard of postoperative recovery defecation time(3 days),367 cases were divided into intestinal dysfunction group,192 cases and non-intestinal dysfunction group 175 cases.The data of the two groups were analyzed by single factor analysis,and logistic regression analysis was performed on the statistically significant factors.The prediction model was initially established and the prediction effect of the model was analyzed.Results Low birth weight,type of locked,and postoperative intravenous nutrition time were independent predictors of postoperative bowel function recovery in children with CIA(P<0.05).The area under the receiver operating characteristic curve of the final prediction model was 0.781(95%CI为0.727~0.835,P<0.001),the Hosmer-Lemeshow test showed that χ^2=7.181,P=0.517.Conclusions Low birth weight,Type of locked and postoperative parenteral nutrition time were independent risk factors of intestinal dysfunction after CIA.The prediction model constructed in this study can better predict the risk of intestinal dysfunction in children after CIA operation,which can provide references for medical staff to implement corresponding management measures.