经后路脊柱侧弯患儿术中压力性损伤风险预测模型的构建

Construction of risk prediction model for intraoperative stress injury in children with posterior scoliosis

目的探讨经后路脊柱侧弯患儿术中压力性损伤的高危因素,并构建相应的风险预测模型。方法2021年10月~2023年2月间长沙市三家三甲医院进行的经后路脊柱侧弯矫形手术的患儿237例。根据是否发生压力性损伤分为损伤组(31例)与未损伤组(206例)。利用单因素分析和多因素Logistic回归分析筛选高危因素,并构建相应的风险预测模型。结果单因素分析结果显示,体质量指数(BMI)、术前皮肤情况、术前低蛋白血症、术前贫血、手术时间、术中体温和术中出血等因素与血管危象的发生有关。BMI、术前皮肤情况、术前低蛋白血症、手术时间和术中出血是影响经后路脊柱侧弯患儿术中压力性损伤发生的高危因素。基于高危因素建立列线图模型,其ROC曲线下面积为0.612,灵敏度为89.7%,特异度91.0%,说明本模型具有较好的风险预测能力。结论BMI、术前皮肤情况、术前低蛋白血症、手术时间和术中出血是影响经后路脊柱侧弯患儿术中压力性损伤发生的高危因素。

Objective The aim of this study was to investigate the high risk factors of intraoperative stress injury in children with posterior spinal scoliosis and to construct a corresponding risk prediction model.Methods A total of 237 cases of orthopaedic surgery for posterior scoliosis performed in three first-class hospitals in Changsha City from October 2021 to February 2023.The patients were divided into injury group(31 cases)and uninjured group(206 cases)according to whether stress injury occurred.The risk factors were screened by single factor analysis and multiple Logistic regression analysis,and the corresponding risk prediction model was constructed.Results The results of single factor analysis showed that constitutional index,preoperative skin condition,preoperative hypoproteinemia,preoperative anemia,operative time,intraoperative body temperature and intraoperative bleeding were related to the occurrence of vascular crisis.BMI,preoperative skin condition,preoperative hypoproteinemia,operative time and intraoperative bleeding are high risk factors for the occurrence of intraoperative stress injury in children with posterior scoliosis.The area under ROC curve is 0.612,the sensitivity is 89.7%,and the specificity is 91.0%,indicating that this model has good risk prediction ability.Conclusion BMI,preoperative skin condition,preoperative hypoproteinemia,operative time and intraoperative bleeding are high risk factors for the occurrence of intraoperative stress injury in children with posterior scoliosis.