新生儿心脏手术术后肺部并发症的危险因素和死亡预测模型构建

Risk factors for pulmonary complication and prediction model for postoperative mortality in neonates under⁃going noncardiac surgery

目的 探讨新生儿心脏手术术后肺部并发症的危险因素并构建术后30 d内死亡的预测模型。方法 回顾性分析2018年9月至2022年2月在医院接受心脏手术的新生儿患者的临床数据。采用单因素和多因素logistic回归分析确定与术后肺部并发症和术后死亡的危险因素。并构建术后30 d内死亡的预测模型。结果 140例患者中,85例(60.7%)合并术后肺部并发症,13例(0.93%)术后30 d内死亡。体外循环手术(P=0.002)和术中使用白蛋白(P=0.038)与术后肺部并发症相关。早产(P=0.01)、急诊手术(P=0.009)和手术时间(P=0.001)是术后30 d内死亡的危险因素,根据这3个危险因素构建了预测术后30 d内死亡的列线图模型,c指数为0.862(95%CI:0.758~0.966),ROC曲线及校准曲线显示该列线图模型具有较好的预测能力。结论 本研究开发和验证的列线图预测模型可用于计算个体化术后死亡风险,能够帮助麻醉医生和临床医生识别高危患儿并制定合理的治疗方案。

Objectives To investigate the risk factors of 30-day mortality and postoperative pulmonary complication in neonatal noncardiac surgery and to establish models for predicting the 30 d mortality.Methods Retrospective analysis of clinical data of newborns undergoing cardiac surgery in hospitals from September 2018 to February 2022.Single factor and multivariate logistic regression analysis were used to determine the risk factors associated with postoperative pulmonary complications and postoperative death.And construct a predictive model for postoperative death within 30 days.survival,as well as constructthe prediction model of 30 d mortality.Results Of 140 patients,85(60.7%) experienced a postoperative pulmonary complication and 13(0.93%) died within 30 d after surgery.Among all factors,cardiopulmonary bypass(P = 0.002)and intraoperative use of albumin(P = 0.038) were associated with PPC.Prematurity(P = 0.01),emergency operation(P = 0.009) and surgery length(P = 0.001) were significant contributors to 30 d mortality.According to these three risk factors,a nomogram model was constructed to predict the 30 d mortality after neonatal noncardiac surgery.The C-index value was 0.862(95% CI:0.758 ~ 0.966),and the receiver operating characteristic curve and calibration curve showed that the nomogram model had a moderate prediction ability.Conclusion The developed and validated nomogram can be used to calculate the individualized risk of postoperative mortality and become a practical tool for anesthetist and clinicians to achieve better treatment for high-risk newborn infants.