老年髋关节置换术病人围手术期内并发心力衰竭的列线图预测模型构建

Establishment of a nomogram prediction model for the risk of heart failure during perioperative period in elderly patients undergoing hip replacement

目的分析探讨老年髋关节置换术病人围手术期内并发心力衰竭(心衰)的风险因素,建立列线图预测模型。方法选取联勤保障部队第940医院198例行髋关节置换术的老年病人,根据围手术期是否并发心衰分为心衰组56例和非心衰组142例。收集所有病人的临床相关资料并进行比较分析,采用Logistic回归分析老年髋关节置换术病人围手术期内并发心衰的影响因素,采用R语言软件包构建列线图预测模型并采用Bootstrap法进行验证。结果心衰组年龄≥70岁、有高血压史、术前美国麻醉医师协会(ASA)分级Ⅲ~Ⅳ级、术中输血量≥400 mL、术后卧床时间≥4 d比例显著高于非心衰组(P<0.05)。多因素Logistic回归结果显示,年龄、高血压史、术前ASA分级、术中输血量、术后卧床时间均是影响老年髋关节置换术病人围手术期内并发心衰的独立危险因素(P<0.05)。列线图模型预测老年髋关节置换术病人围手术期内并发心衰的预测值与实测值基本一致。ROC曲线验证列线图模型的AUC为0.901,预测效能较高。结论依据老年髋关节置换术病人围手术期内并发心衰的危险因素构建的列线图模型有较高的预测效能。

Objective To analyze the risk factors of heart failure(HF)during perioperative period in the elderly patients undergoing hip replacement,and to establish a nomogram prediction model.Methods A total of 198 elderly patients who underwent hip replacement in the 940th Hospital of the Joint Support Force were enrolled and divided into heart failure group(56 patients)and non-heart failure group(142 patients)according to whether the patients presented with HF during perioperative period.The clinical data of the patients were collected and compared between the two groups.Multiple Logistic regression analysis was used to examine the influencing factors of perioperative HF in the elderly patients undergoing hip replacement.R language software package was used to construct the nomogram prediction model which was verified by Bootstrap method.The area under the receiver operator characteristic(ROC)curve was used to test the predictive efficacy of the nomogram model.Results The proportions of aged≥70 years old,hypertension,preoperative American Society of Anesthesioloogists(ASA)gradeⅢ-Ⅳ,the volume of intraoperative blood transfusion≥400 mL and the time of postoperative bed rest≥4 days in the heart failure group were obviously higher than those in the non-heart failure group(P<0.05).Logistic regression analysis showed that age,history of hypertension,preoperative ASA classification,intraoperative blood transfusion volume and postoperative bed rest time were independent risk factors for perioperative HF in the elderly patients undergoing hip replacement(P<0.05).The predicted value of nomogram model for HF in the elderly patients undergoing hip replacement during perioperative period was basically consistent with the measured value.The area under the ROC curve of the nomogram model was 0.901,with high predictive efficiency.Conclusion The nomogram based on the risk factors of AHF in the elderly patients undergoing hip replacement during perioperative period has a high predictive efficacy.