长期抗凝治疗老年患者胃癌切除术后出血风险预测模型的建立

Establishment of a predictive model for postoperative bleeding risk in elderly patients receiving long-term anticoagulants after radical gastrectomy

目的分析长期服用抗凝药物的老年患者胃癌切除术后大出血的风险因素并建立预测模型,为临床护理工作提供参考。方法回顾性分析30例胃切除术后出血(观察组)和200例胃切除术后未出血或少出血的老年胃癌患者(对照组)的临床资料。Logistic回归分析患者术后出血的危险因素,建立出血风险预测模型。采用ROC曲线评估风险预测模型的预测性能。比较观察组和对照组术后临床表现的差异。结果多因素分析显示,血小板<100×10^(9)/L、TNM分期Ⅲ期和腹部感染是长期抗凝老年患者胃癌切除术后出血的独立危险因素,据此建立的出血预测模型的AUC为0.736(95%CI:0.674~0.791),灵敏度为60.00%,特异度为79.00%。观察组患者术后出现呕血、黑便及引流液异常临床表现的比例显著高于对照组(P<0.05)。结论血小板水平较低、晚期患者及术后腹部感染是长期抗凝的老年患者胃癌切除术后大出血的独立危险因素,对该类患者临床护理人员需结合临床表现警惕术后出血的发生。

Objective To establish a risk predictive model for postoperative bleeding risks in elderly gastric cancer patients receiving long-term anticoagulants after gastrectomy,and to provide reference for nursing care work.Methods A total of 30 gastric cancer patients with bleeding after gastrectomy(an observation group)and 200 elderly gastric cancer patients with little or without bleeding after gastrectomy(a control group)were analyzed,and their clinical data were retrospectively analyzed.The risk factors of postoperative bleeding were screened out by Logistic regression analysis to establish a predictive model for bleeding risks.A receiver operating characteristic(ROC)curve was used to evaluate the predictive performance of the risk predictive model.Both groups were compared for their postoperative clinical manifestation.Results Multivariate analysis showed that platelets<100×10^(9)/L,TNM stageⅢand abdominal infection were independent risk factors for postoperative bleeding in elderly patients receiving long-term anticoagulants after gastrectomy.The AUC of the established predictive model was 0.736(95%CI:0.674—0.791),with a sensitivity of 60.00%and a specificity of 79.00%.The incidence of hematemesis,black stool and abnormal drainage fluid in the observation group was significantly higher than that in the control group(P<0.05).Conclusions Low platelet level,advanced patients and postoperative abdominal infection were the independent risk factors of postoperative bleeding in elderly patients receiving long-term anticoagulants after gastrectomy.It is necessary for medical nurses to be alert for the occurrence of postoperative bleeding according to clinical feature.