先天性肠闭锁患儿术后肠功能恢复不良的影响因素及其预测模型构建

Influencing Factors and Predictive Model Construction of Poor Intestinal Function Recovery after Operation in Children with Congenital Intestinal Atresia

目的:探讨先天性肠闭锁患儿术后肠功能恢复不良的影响因素,并构建预测模型。方法:选择2020年3月至2023年3月河北省儿童医院收治的126例先天性肠闭锁患儿,统计术后肠功能恢复情况,根据术后肠功能恢复情况将患儿分为恢复不良组和恢复良好组。多因素Logistic回归分析先天性肠闭锁患儿术后肠功能恢复不良的影响因素,基于Logistic回归构建预测模型。受试者工作特征(ROC)曲线分析预测模型鉴别先天性肠闭锁患儿术后肠功能恢复不良的价值。结果:126例先天性肠闭锁患儿中术后肠功能恢复不良共37例,恢复良好89例。恢复不良组出生体重、术后肠内营养支持比例低于恢复良好组(P<0.05),Grosfeld病理分型Ⅳ型、空肠闭锁、早产儿比例高于恢复良好组(P<0.05),吻合口直径大于恢复良好组(P<0.05)。多因素Logistic回归分析显示早产儿、空肠闭锁、Grosfeld病理分型IV型是术后肠道功能恢复不良的危险因素(P<0.05),术后肠内营养支持是保护因素(P<0.05)。基于Logistic回归构建的预测模型预测先天性肠闭锁患儿术后肠功能恢复不良的曲线下面积为0.852,灵敏度、特异度分别为83.78%、85.39%。Hosmer-Lemeshow检验P>0.05,模型拟合效果良好。结论:早产儿、空肠闭锁、Grosfeld病理分型IV型是术后肠道功能恢复不良的危险因素,术后肠内营养支持是保护因素。基于Logistic回归构建的预测模型对于先天性肠闭锁患儿术后肠功能恢复不良具有较好的预测价值。

Objective:To explore the influencing factors of poor intestinal function recovery after operation in children with congenital intestinal atresia,and to construct a predictive model.Methods:126 children with congenital intestinal atresia who were admitted to Hebei Children's Hospital from March 2020 to March 2023 were selected,intestinal function recovery after operation was counted,children were divided into poor recovery group and good recovery group according to intestinal function recovery after operation.The influencing factors of poor intestinal function recovery after operation in children with congenital intestinal atresia were analyzed by multivariate Logistic regression,and the predictive model was constructed based on Logistic regression.The value of predictive model in distinguishing postoperative poor intestinal function recovery after operation in children with congenital intestinal atresia were analysised by receiver operating characteristic(ROC)curve.Results:37 cases had poor intestinal function recovery after operation among 126 children with congenital intestinal atresia,and 89 cases had good recovery.The birth weight and the proportion of enteral nutrition support after operation in poor recovery group were lower than those in good recovery group(P<0.05),the proportion of Grosfeld pathological type IV,jejunal atresia and premature infants in poor recovery group were higher than those in good recovery group(P<0.05),the anastomotic diameter in poor recovery group was larger than that in good recovery group(P<0.05).Multivariate Logistic regression analysis showed that premature infants,jejunal atresia and Grosfeld pathological type IV were risk factors for poor intestinal function recovery after operation(P<0.05),and enteral nutrition support after operation was a protective factor(P<0.05).The area under the curve of the predictive model based on Logistic regression to predict poor intestinal function recovery after operation in children with congenital intestinal atresia was 0.852,and the sensitivity and specificity were 83.78%and 85.39%respectively.Hosmer-Lemeshow test P>0.05,the model fitting effect was good.Conclusion:Premature infants,jejunal atresia and Grosfeld pathological type IV are risk factors for poor intestinal function recovery after operation,and enteral nutrition support after operation is a protective factor.The predictive model base on Logistic regression has a good predictive value for poor intestinal function recovery after operation in children with congenital intestinal atresia.