骨科俯卧位患者术中压力性损伤风险预测模型的构建

Construction of risk prediction model for intraoperative pressure injury in orthopedic prone position patients

目的:探讨影响骨科俯卧位患者术中压力性损伤风险的相关因素并构建风险预测模型。方法:根据是否发生术中压力性损伤将310例骨科俯卧位手术患者分为损伤组(n=37)和未损伤组(n=273)。采用Logistic回归分析骨科俯卧位患者发生术中压力性损伤的独立风险因素,并构建骨科俯卧位患者术中压力性损伤风险预测模型,应用受试者工作特征(ROC)曲线评价预测模型的诊断效能。结果:310例患者中,37例术中发生压力性损伤,损伤发生率为11.94%。两组患者年龄、BMI、吸烟史、糖尿病史、低蛋白血症、二便失禁、麻醉分级及手术时间比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄、BMI偏高、有糖尿病史、二便失禁及手术时间长是骨科俯卧位患者术中发生压力性损伤的独立风险因素(P<0.05)。根据多因素回归分析结果构建骨科俯卧位患者术中发生压力性损伤的列线图预测模型,ROC曲线下面积(AUC)为0.976(95%CI为0.952~0.990)、灵敏度为97.3%、特异度为90.8%。结论:高龄、BMI偏高,糖尿病史、二便失禁及手术时间长是骨科俯卧位患者术中压力性损伤的独立风险因素,构建的列线图模型能较好的预测骨科俯卧位患者术中压力性损伤的发生风险。

Objective:To analyze the related factors affecting the risk of intraoperative stress injury in patients with orthopedic prone position and to construct a risk prediction model.Methods:310 patients who underwent orthopedic prone position surgery were divided into the injury group(n=37) and the non-injury group(n=273) according to whether intraoperative stress injury occurred.Logistic regression was used to analyze the independent risk factors of intraoperative pressure injury in orthopedic prone position patients, and the risk prediction model of intraoperative pressure injury in orthopedic prone position patients was constructed.The diagnostic efficiency of the prediction model was evaluated by receiver operating characteristic(ROC) curve.Results:Among 310 patients, 37 patients had pressure injury during operation, and the incidence of injury was 11.94 %.There were statistically significant differences in age, BMI,smoking history, diabetes history, hypoproteinemia, fecal incontinence, anesthesia classification and operation time between the two groups(P<0.05).Multivariate Logistic regression analysis showed that elderly age, high BMI,history of diabetes, fecal incontinence and long operation time were independent risk factors for intraoperative stress injury in orthopedic prone patients(P<0.05).According to the results of multivariate regression analysis, the predictive model of intraoperative pressure injury in orthopedic prone position was constructed.The AUC under the curve was 0.976(95%CI:0.952~0.990),the sensitivity was 97.3%,and the specificity was 90.8%.Conclusion:Old age, high BMI,diabetes history, incontinence and long operation time are independent risk factors for intraoperative stress injury in orthopedic prone position patients.The line graph model based on the above risk factors can better predict the risk of intraoperative pressure injury in orthopedic prone position patients.