儿童支气管异物取出术后并发症风险预测模型的构建和验证

王莉; 倪春梅; 仇丽; 徐金梅; 王蓓

doi:10.16766/j.cnki.issn.1674-4152.002970

儿童支气管异物取出术后并发症风险预测模型的构建和验证

doi: 10.16766/j.cnki.issn.1674-4152.002970

扬州大学附属医院儿科，江苏扬州 225000

基金项目:

江苏省卫生健康委科研项目 M2021076

详细信息

通讯作者:
王蓓，E-mail：30919533@qq.com

中图分类号: R619 R725.6
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出版历程
- 收稿日期: 2023-01-05

Construction and validation of a risk prediction model for complications after bronchial foreign body removal in children

Department of Pediatrics, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, China

摘要

摘要: 目的小儿支气管异物取出术后可伴随喉水肿等严重并发症，构建该类患者术后并发症预测模型，以期为临床防治提供依据。方法选取2000年1月—2022年12月扬州大学附属医院在扬州大学附属医院就诊的107例支气管异物患儿作为研究对象，采用随机数字表法，按照7∶ 3的比例随机分为建模组(74例)和验证组(33例)。根据患儿术后3个月是否发生并发症将建模组分为并发症组(12例)和无并发症组(62例)。收集患儿资料采用logistic回归分析支气管异物取出术后并发症发生的影响因素，使用R软件构建预测模型，并对模型进行验证。结果年龄较大(P＜0.001)、病程较长(P＜0.001)、异物长径较长(P＜0.001)及诊断至取出时间较长(P＜0.029)为小儿支气管异物取出术后并发症发生的独立危险因素(P＜0.05)；H-L拟合度曲线(有效性)示，建模组χ²=6.856，P=0.427；验证组χ²=6.125，P=0.351。ROC曲线(区分度)示，建模组ROC曲线下面积为0.901(95% CI：0.862~0.933)，敏感性为82.61%、特异性为86.22%；验证组ROC曲线下面积为0.852(95% CI：0.806~0.890)，敏感性为82.61%、特异性为73.62%。结论年龄较大、病程较长、异物长径较长及诊断至取出时间较长为小儿支气管异物取出术后并发症发生的独立危险因素。
- 支气管异物取出术 /
- 并发症 /
- 危险因素 /
- 儿童
Abstract: Objective To establish a predictive model for postoperative complications in children with laryngeal edema after removal of bronchial foreign bodies, so as to provide evidence for clinical prevention and treatment. Methods A total of 107 children with bronchial foreign bodies admitted to the Affiliated Hospital of Yangzhou University from January 2000 to December 2022 were selected as the study objects children with bronchial foreign bodies treated in the Affiliated Hospital of Yangzhou University were selected as research subjects, and were randomly divided into modeling group (74 cases) and verification group (33 cases) according to the ratio of 7:3, using the random number table method. The modeling group was divided into complication group (12 cases) and non-complication group (62 cases) according to whether complications occurred 3 months after surgery. Logistic regression was used to analyze the factors influencing complications after removal of bronchial foreign bodies. The R software was used to construct a prediction model and the model was verified. Results Older age (P < 0.001), longer disease duration (P < 0.001), longer length diameter of the foreign body (P < 0.001) and longer time from diagnosis to removal (P < 0.029) were independent risk factors for postoperative complications of bronchial foreign body removal in children (P < 0.05). H-L fit curve (validity) shows that modeling group χ²=6.856, P=0.427; verification group χ²=6.125, P=0.351. The ROC curve (differentiation) showed that the area under ROC curve of the modeling group was 0.901 (95% CI: 0.862-0.933), the sensitivity was 82.61% and the specificity was 86.22%. In the verification group, the area under the ROC curve was 0.852 (95% CI: 0.806-0.890), the sensitivity was 82.61% and the specificity was 73.62%. Conclusion Older age, longer disease duration, longer foreign body length and longer time from diagnosis to removal are independent risk factors for postoperative complications of bronchial foreign body removal in children.
- Removal of bronchial foreign body /
- Complications /
- Risk factors /
- Children
利益冲突 无

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图 1 小儿支气管异物取出术后并发症发生的预测模型

Figure 1. Prediction model of complications after removal of bronchial foreign bodies in children

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图 2 建模组预测小儿支气管异物取出术后并发症发生的H-L拟合度曲线

Figure 2. H-L fitting degree curve of the modeling group predicting complications after removal of bronchial foreign bodies in children

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图 3 验证组预测小儿支气管异物取出术后并发症发生的H-L拟合度曲线

Figure 3. H-L fitting degree curve for predicting complications after removal of bronchial foreign bodies in children in the verification group

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图 4 建模组预测小儿支气管异物取出术后并发症发生的ROC曲线

Figure 4. ROC curve of the modeling group predicting complications after removal of bronchial foreign bodies in children

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图 5 验证组预测小儿支气管异物取出术后并发症发生的ROC曲线

Figure 5. ROC curve for predicting complications after removal of bronchial foreign bodies in children in the verification group

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表 1 小儿支气管异物取出术后并发症发生因素的单因素分析

Table 1. Univariate analysis of complications after removal of bronchial foreign bodies in children

项目	并发症组(n=12)	无并发症组(n=62)	统计量	P值
年龄(x±s，岁)	3.45±0.56	3.11±0.43	2.384^a	0.020
病程(x±s，d)	7.42±1.23	6.35±1.02	3.217^a	0.002
性别[例(%)]			0.398^b	0.528
男	7(58.33)	30(48.39)
女	5(41.67)	32(51.61)
异物性质[例(%)]			0.411^b	0.681
植物性	6(50.00)	28(45.16)
动物性	4(33.33)	20(32.26)
其他	2(16.67)	14(22.58)
异物位置[例(%)]			0.048^b	0.962
左侧支气管	6(50.00)	32(51.61)
右侧支气管	4(33.33)	17(27.42)
双侧气道	2(16.67)	13(20.97)
异物长径(x±s，mm)	7.56±1.31	6.47±1.13	2.981^a	0.004
临床表现[例(%)]
发热	4(33.33)	18(29.03)	0.002^b	0.963
呼吸困难	5(41.67)	21(33.87)	0.268^b	0.605
咳嗽	11(91.67)	54(87.10)	0.044^b	0.834
气喘	10(83.33)	53(85.48)	0.063^b	0.801
异物形状[例(%)]			0.128^b	0.898
长条形	4(33.33)	22(35.48)
圆形	6(50.00)	30(48.39)
不规则形	2(16.67)	10(16.13)
异物数量[例(%)]			4.182^b	0.041
1个	4(33.33)	43(69.35)
≥2个	8(66.67)	19(30.65)
诊断至取出时间[例(%)]			7.291^b	0.007
＜2 h	3(25.00)	44(70.97)
2~4 h	9(75.00)	18(29.03)
异物滞留时间[例(%)]			0.004^b	0.947
0~4 d	8(66.67)	45(72.58)
＞4 d	4(33.33)	17(27.42)
注：^a为t值，^b为χ²值。

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表 2 影响小儿支气管异物取出术后并发症发生的多因素logistic回归分析

Table 2. Logistic regression analysis of multiple factors affecting complications after removal of bronchial foreign bodies in children

项目	B	SE	Wald χ²	P值	OR值	95% CI
年龄	1.753	0.526	11.099	0.001	5.772	2.058~16.191
病程	1.127	0.222	25.758	﹤0.001	3.086	1.997~4.768
异物长径	0.756	0.187	16.267	＜0.001	2.129	1.475 ~3.074
异物数量	0.809	0.433	3.483	0.062	2.245	0.960~5.248
诊断至取出时间	0.922	0.422	4.767	0.029	2.515	1.099~5.755

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