新生儿肺透明膜病经鼻持续正压通气治疗中通气压力不稳定风险的列线图模型构建

Construction of a nomogram model for risk of unstable ventilation pressure during nasal continuous positive airway pressure treatment for hyaline membrane disease in neonates

目的分析新生儿肺透明膜病(HMD)患儿经鼻持续正压通气(NCPAP)治疗中通气压力不稳定的影响因素并构建列线图模型。方法回顾性选取行NCPAP治疗的157例HMD患儿作为研究对象,根据治疗中有无发生通气压力不稳定分为不稳定组49例和稳定组108例。采用Logistic回归模型分析HMD患儿NCPAP治疗中通气压力不稳定的影响因素,利用R软件构建列线图模型,并通过受试者工作特征(ROC)曲线、校准曲线、Hosmer-Lemeshow拟合优度检验评估列线图模型的预测效能。结果49例HMD患儿NCPAP治疗中发生通气压力不稳定,发生率为31.21%(49/157)。单因素分析显示,NCPAP治疗中通气压力不稳定与患儿的胎龄、性别、出生体质量、分娩方式、新生儿Apgar评分以及NCPAP治疗中导管扭曲、管内冷凝水过多无关(P>0.05);NCPAP治疗时间、鼻黏膜损伤、分泌物堵塞气道、躁动是HMD患儿NCPAP治疗中通气压力不稳定的影响因素(P<0.05)。多因素Logistic回归分析显示,NCPAP治疗时间≥72 h、鼻黏膜损伤、分泌物堵塞气道、躁动为HMD患儿NCPAP治疗中通气压力不稳定的独立危险因素(P<0.05),基于4项独立危险因素构建列线图模型。ROC曲线显示,该列线图模型的区分度良好,曲线下面积为0.801(95%CI:0.730~0.861);Hosmer-Lemeshow拟合优度检验结果显示χ^(2)=3.550,P=0.470,校准曲线斜率接近1,提示该列线图预测模型的拟合效度良好。结论基于NCPAP治疗时间、鼻黏膜损伤、分泌物堵塞气道、躁动构建的列线图模型,对HMD患儿NCPAP治疗中是否发生通气压力不稳定具有较好的预测价值。

Objective To analyze the influencing factors of unstable ventilation pressure during nasal continuous positive airway pressure(NCPAP)treatment in neonates with hyaline membrane disease(HMD)and construct a nomogram model.Methods A retrospective analysis was conducted in 157 HMD neonates who underwent NCPAP treatment.The patients were divided into unstable group(n=49)and stable group(n=108)based on the occurrence of unstable ventilation pressure during treatment.Logistic regression analysis was used to identify influencing factors of unstable ventilation pressure during NCPAP treatment in HMD neonates.A nomogram model was constructed using R software,and its predictive performance was evaluated using receiver operating characteristic(ROC)curves,calibration curves,and the Hosmer-Lemeshow goodness-of-fit test.Results Unstable ventilation pressure occurred in 49 HMD neonates during NCPAP treatment,with an incidence rate of 31.21%(49/157).Univariate analysis showed that unstable ventilation pressure during NCPAP treatment had no relation to gestational age,gender,birth weight,delivery mode,neonatal Apgar score,catheter distortion,or excessive condensation in the tube(P>0.05).However,NCPAP treatment duration,nasal mucosa damage,secretion blockage in the airway,and restlessness were identified as influencing factors for unstable ventilation pressure during NCPAP treatment in HMD neonates(P<0.05).Multivariate Logistic regression analysis revealed that NCPAP treatment duration≥72 h,nasal mucosa damage,secretion blockage in the airway,and restlessness were independent risk factors for unstable ventilation pressure during NCPAP treatment in HMD neonates(P<0.05).A nomogram model was constructed based on these four independent risk factors.The ROC curve demonstrated good discrimination for the nomogram model,with an area under the curve of 0.801(95%CI,0.730 to 0.861).The Hosmer-Lemeshow goodness-of-fit test showed a chi-square value of 3.550 with a P-value of 0.470,and the calibration curve had a slope close to 1,indicating good fit validity for the nomogram prediction model.Conclusion The nomogram model constructed based on NCPAP treatment duration,nasal mucosa damage,secretion blockage in the airway,and restlessness has good predictive value for the occurrence of unstable ventilation pressure during NCPAP treatment in HMD neonates.