脑肿瘤切除手术患儿术中压力性损伤风险预测模型的构建

Construction of Risk Prediction Model of Intraopratively Acquired Pressure Injuries in Children Undergoing Brain Tumor Resection

目的分析儿童脑肿瘤术中压力性损伤(intraopratively acquired pressure injuries,IAPIs)的危险因素,建立其风险列线图模型,为儿童脑肿瘤IAPIs预防策略提供依据。方法收集2019年8月至2021年2月接受脑肿瘤手术治疗460例患儿临床资料。通过单因素和Logistic分析IAPIs发生风险因素,用R软件构建其列线图模型,利用受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积判断列线图模型预测能力,并计算一致性指数(index of concordance,C-index)评价模型区分度,绘制校准曲线评估预测结果与实际结果一致性。结果Logistic分析显示:年龄、术中出血、术中体温、术中使用升压药、手术时间是IAPIs独立危险因素(均P<0.05);ROC提示列线图模型有较好区分度;内部验证C-index值为0.956,外部验证C-index值为0.981;校准曲线显示预测结果与实际结果之间有较好一致性。结论本研究分析脑肿瘤切除手术患儿术中压力性损伤相关风险因素,构建列线图预测模型有较好预测价值,可为临床个体化预测儿童脑肿瘤手术中IAPIs发生风险提供参考。

Objective To analyze the risk factors of intraopratively acquired pressure injuries(IAPIs)in children undergoing brain tumor resection and establish a risk prediction model.Methods From August 2019 to February 2021,clinic data of 460 children undergoing brain tumor resection were enrolled.The risk factors of IAPIs were analyzed by single factor and Logistic analysis,and the nomogram model was constructed by R software.The predictive ability of the nomogram model was judged by the area under receiver operating characteristic curve(ROC),and the model differentiation was evaluated by the consistency index(C-index).A calibration curve was drawn to evaluate the consistency between the predicted results and the actual results.Results Logistic analysis showed that age,intraoperative bleeding,intraoperative body temperature,intraoperative use of pressors and operative time were independent risk factors for IAPIs(all P<0.05).ROC suggested that the line graph model had good differentiation.The C-index value of internal verification was 0.956,and the C-index value of external verification was 0.981.The calibration curve showed a good agreement between the predicted results and the actual results.Conclusions The analysis of related risk factors of IAPIs and the construction of a nomogram prediction model in this study are of good predictive value,which can provide reference for individualized clinical prediction of the risk of pressure injury during pediatric brain tumor surgery.