个体化预测老年患者腹腔镜下腹股沟疝修补术后尿潴留的风险Nomogram模型的建立

Establishment of an individualized Nomogram model for predicting the risk of urinary retention after laparoscopic inguinal hernia repair in elderly patients

目的构建个体化预测老年患者腹腔镜下腹股沟疝修补术(LIHR)后尿滞留(POUR)的风险nomogram模型。方法回顾性分析2016年1月至2020年1月于无锡市锡山人民医院行LIHR的老年腹股沟疝患者223例的临床资料。使用单因素和Logistic回归多因素分析老年患者行LIHR发生POUR的独立危险因素,并建立相关nomogram预测模型。结果年龄>74岁(OR=3.343,95%CI:1.293~8.639)、良性前列腺肥大(OR=6.293,95%CI:1.932~20.503)、手术时间≥90 min(OR=4.287,95%CI:1.689~10.879)、术后使用麻醉类镇痛药物(OR=6.560,95%CI:2.383~18.062)、术后首次排尿时间≥5 h(OR=7.291,95%CI:2.779~19.128)是老年患者行LIHR发生POUR的独立危险因素(P<0.05)。基于以上5项独立危险因素建立预测老年患者行LIHR发生POUR的nomogram模型,并对该模型进行内部验证显示,校正曲线与理想曲线拟合较好,预测值同实测值基本一致,AUC高达0.874(95%CI:0.842~0.906),表明该nomogram模型具有良好的预测能力。结论老年患者行LIHR发生POUR的独立危险因素较多,本研究建立的nomogram模型具有准确的预测能力,可为临床筛查高风险患者和采取有效的临床对策提供参考依据。

Objective To construct a nomogram model that can individually predict the risk of urine retention(POUR)after laparoscopic inguinal hernia repair(LIHR)in elderly patients.Methods The clinical data of elderly patients with inguinal hernia who underwent LIHR in our hospital from January 2016 to January 2020 were retrospectively analyzed.Single factor and logistic regression were used to analyze the independent risk factors of POUR in elderly patients under LIHR.Establish relevant nomogram prediction models.Results Age>74 years old(OR=3.343,95%CI:1.293-8.639),benign prostatic hypertrophy(OR=6.293,95%CI:1.932-20.503),operation time≥90 min(OR=4.287,95%CI:1.689-10.879),postoperative use of narcotic analgesics(OR=6.560,95%CI:2.383-18.062),postoperative first micturition time≥5 h(OR=7.291,95%CI:2.779-19.128)are independent risk factors in elderly patients for POUR in LIHR(P<0.05).Based on the above 5 independent risk factors,a nomogram model was established to predict the occurrence of POUR in elderly patients undergoing LIHR,and internal verification of the model showed that the calibration curve fits the ideal curve well,and the predicted value is basically the same as the measured value.AUC is as high as 0.874(95%CI:0.842-0.906),indicating that the nomogram model has good predictive ability.Conclusion There are many independent risk factors for POUR in elderly patients undergoing LIHR.The nomogram model established in this study has accurate predictive ability and can provide reference for clinical screening of high-risk patients and effective clinical countermeasures.