早期胃癌内镜黏膜下剥离术后迟发性出血风险预警模型研究

Early warning model of delayed bleeding after endoscopic submucosal dissection for early gastric cancer

目的探讨影响早期胃癌患者内镜黏膜下剥离术后迟发性出血的危险因素,建立风险预警模型并进行验证。方法选取2020年1月至2023年1月在医院行内镜黏膜下剥离术的早期胃癌患者180例为研究对象,依据患者是否发生术后迟发性出血将其分为术后迟发性出血组和非术后迟发性出血组。并对其临床资料进行单因素和多因素回归分析,得出独立预测因素,基于此构建列线图风险模型,并对该模型进行预测效能的评价。结果180例患者中,术后迟发性出血发生率为18.33%。单因素分析结果显示,患者病灶部位、病灶直径、浸润深度、长期服用抗血栓药物、活检次数、溃疡和瘢痕、手术时间、术中出血量、D-二聚体、血小板计数、血浆凝血酶原时间和活化部分凝血活酶时间是影响早期胃癌患者内镜黏膜下剥离术后发生术后迟发性出血的主要因素,其中,病灶部位位于贲门、长期服用抗血栓药物、溃疡和瘢痕、手术时间和活化部分凝血活酶时间是独立危险因素(P<0.05)。模型C-index指数为0.992,与1000次Bootstrap内部验证的C-index指数0.990较为接近,模型校正曲线总体趋势接近理想曲线。结论早期胃癌患者行内镜黏膜下剥离术后迟发性出血的发生受多重因素共同影响,根据危险因素建立的风险预警模型具有较好的预测效能,有助于临床护理人员识别早期胃癌患者内镜黏膜下剥离术后迟发性出血高危患者。

Objective To explore the risk factors of delayed bleeding after endoscopic submucosal dissection in patients with early gastric cancer and establish a risk warning model.Methods A total of 180 patients with early gastric cancer who underwent endoscopic submucosal dissection from January 2020 to January 2023 were selected as the study objects.The patients were divided into the delayed postoperative bleeding group and non-delayed postoperative bleeding group according to whether the patients had delayed postoperative bleeding.The clinical data were collected for univariate and multivariate regression analysis to obtain the independent predictive factors,and build a nomogram risk model based on that,and evaluate the predictive efficacy of the model.Results The incidence of postoperative delayed hemorrhage was 18.33%.The results of univariate analysis showed that lesion site,lesion diameter,depth of infiltration,long-term administration of antithrombotic drugs,number of biopsies,ulcer and scar,operation time,intraoperative blood loss,D-D,PT,APTT and PLT were the main factors affecting postoperative delayed bleeding after endoscopic submucosal dissection in patients with early gastric cancer.The lesion was located in the cardia,accompanied by cardiac lesion,long-term use of antithrombotic drugs,ulcers and scars,operation time and APTT were independent risk factors(P<0.05).The C-index index of the model was 0.992,which was close to the C-index of 0.990 verified with Bootstrap for 1000 times.The overall trend of the model correction curve was close to the ideal curve.Conclusion The occurrence of delayed bleeding after endoscopic submucosal dissection in early gastric cancer patients is affected by multiple factors.The risk early warning model established based on risk factors has good predictive efficacy,which is helpful for clinical nurses to identify high-risk patients with delayed bleeding after endoscopic submucosal dissection in early gastric cancer patients.