摘要
目的 分析老年泌尿系统结石患者内镜手术后静脉血栓栓塞症(VTE)发生的危险因素,构建VTE发生的预测模型并进行效能评估.方法 回顾性分析2018年1月—2023年1月在海南省肿瘤医院泌尿外科行内镜手术治疗的402例老年(≥60岁)泌尿系统结石患者的临床资料,根据术后是否发生VTE分为VTE组(n=43)和非VTE组(n=359).采用单因素分析、多因素logistic回归分析筛选术后VTE发生的危险因素.根据筛选结果(P＜0.05的因素)建立列线图预测模型,通过绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)判断模型预测效能;绘制校准图,对模型校准度进行判断.结果 单因素分析结果显示,年龄＞70岁、身体质量指数(BMI)≥30、VTE病史、恶性肿瘤病史、糖尿病、手术时间＞180 min、术中应用利尿剂、术后下床活动时间＞24 h是老年泌尿系统结石患者内镜手术后VTE发生的危险因素(P＜0.05).logistic回归分析显示年龄＞70岁、BMI≥30、VTE病史、恶性肿瘤病史及手术时间＞180 min是患者手术后VTE发生的独立危险因素(P＜0.05).建立预测模型后,模型的ROC曲线的AUC为0.789(95％CI:0.731～0.848,P＜0.001).校准图显示校准曲线与标准曲线接近(Brier=0.13).结论 年龄＞70岁、BMI≥30、VTE病史、恶性肿瘤病史及手术时间＞180 min是老年泌尿系统结石患者内镜手术后VTE发生的独立危险因素,所构建的预测模型对术后VTE的发生有较高的预测价值.
Abstract
Objective To analyze the risk factors of venous thromboembolism(VTE)after endoscopic surgery in elderly patients with urinary system calculi,construct a prediction model and validate it.Methods A retrospective analysis was conducted on the clinical data of 402 elderly patients(≥ 60 years)with urinary system calculi who underwent endoscopic surgery in our hospital during Jan.2018 and Jan.2023.The patients were divided into VTE group(n=43)and non-VTE group(n=359)based on whether VTE occurred after surgery.Risk factors of VTE were screened with univariate and multivariate logistic regression analyses.Based on the screening results(P＜0.05 for the factor),a nomogram prediction model was established,the receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated to determine the efficacy of the model,and a calibration chart was drawn to determine the accuracy of the model.Results Univariate analysis showed that age＞70 years,body mass index(BMI)≥30,VTE history,history of malignant tumors,diabetes,operation time＞180 min,diuretic use during operation,and postoperative ambulation time＞24 h were risk factors of VTE(P＜0.05).Logistic regression analysis showed that age＞70 years,BMI ≥ 30,history of VTE,history of malignant tumors,and operation time＞180 min were independent risk factors of VTE(P＜0.05).The AUC in the ROC curve of the validation set data was 0.789(95％CI:0.731-0.848,P＜0.001).The calibration chart showed that the calibration curve was close to the standard curve(Brier=0.13).Conclusion Age＞70 years,BMI ≥30,history of VTE,history of malignant tumors,and surgery time＞180 min are independent risk factors of postoperative VTE in elderly patients with urinary system calculi undergoing endoscopic surgery.The prediction model can effectively predict the risk factors of postoperative VTE.
维普
万方数据