To explore the influencing factors of postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia based on the nomogram model
To explore the influencing factors of postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia based on the nomogram model
Objective To explore the influencing factors of postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia based on the nomogram model.Methods Data of 105 patients undergoing laparoscopic cholecystectomy under general anesthesia from October 2018 to October 2020 were retrospectively analyzed.According to whether postoperative intestinal dysfunction occurred,the patients were divided into disordered group(n=26)and normal group(n=79).SPSS 22.0 software was used for statistical analysis,multi-factor Logistic regression was used to analyze the influencing factors of postoperative intestinal dysfunction in patients,and R(R3.5.3)software package and rms package were used to make a nomogram model and verify it.The risk stratification system was established by recursive segmentation analysis(RPA),and subgroup analysis was performed.Survival curves were drawn by Kaplan-Meier and compared by Log-Rank test.P＜0.05 was considered statistically significant.Results The intestinal sound recovery time,first venting time,first defecation time,abdominal distension score and abdominal pain score of patients with disorder group were higher than those of normal group(P＜0.05),and the levels of diamine oxidase,D-lactic acid,tumor necrosis factor a(TNF-a),interleukin-6(IL-6)and staphylococcus were higher than those of normal group.The level of lactobacillus was lower than that of normal group(P＜0.05).Multivariate Logistic regression analysis showed that diamine oxidase,D-lactic acid,TNF-a,IL-6 and staphylococcus were independent influencing factors for postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under general anesthesia,and lactobacillus was the protective factor(P＜0.05).The value of the nomogram model constructed according to independent influencing factors was AUC before and after internal validation were 0.849(95％CI:0.738～0.892)and 0.827(95％CI:0.721～0.863),sensitivity was 88.2％and 87.9％,specificity was 92.5％and 91.4％,respectively.and the differentiation and validity of the model prediction were good.The decision curve shows that when the threshold probability is between 1.0％and 90.0％,there is a higher net benefit value.The risk stratification system divided all patients into four risk groups,and the risk stratification system could distinguish patient survival(P＜0.05).Conclusion After laparoscopic cholecystectomy under general anesthesia,patients with abnormal levels of diamine oxidase,D-lactic acid,TNF-a,IL-6,lactobacillus,staphylococcus and other indicators should pay attention to the occurrence of intestinal function disorders.
关键词
麻醉,全身/胆囊切除术,腹腔镜/肠道功能紊乱/列线图模型/影响因素分析
Key words
Anesthesia,General/Cholecystectomy,Laparoscopic/Intestinal Dysfunction/Nomogram Model/Root Cause Analysis
维普
万方数据