婴幼儿法洛四联症完全矫治术后重症监护室滞留的危险因素及列线图模型构建OA北大核心CSTPCD
Risk factors and nomogram model construction for prolonged intensive care unit stay after complete correction of tetralogy of Fallot in infants and young children
目的 探讨婴幼儿法洛四联症(tetralogy of Fallot,TOF)完全矫治术后重症监护室(inten-sive care unit,ICU)滞留的危险因素,并构建具有预测术后ICU滞留风险性能的列线图.方法 回顾性分析2021年1月至2024年3月于郑州大学华中阜外医院行一期完全矫治术的157例TOF患儿资料,根据术后是否发生ICU滞留分为滞留组(n=40)和非滞留组(n=117).收集患儿术前体重,结果采用最小绝对收缩与选择算子(the least absolute shrinkage and selection operator,LASSO)回归、单因素及多因素Logistic回归分析,确定术后ICU滞留的独立预测因素,在此基础上绘制列线图,并采用受试者操作特征(receiver operating characteristic,ROC)曲线评价列线图的预测价值.结果 多因素Logistic回归分析显示,患儿术前低体重(OR=0.607,95％CI:1.391～0.890,P=0.015)、中性粒细胞-淋巴细胞比值高(OR=2.499,95％CI:1.483～4.680,P＜0.001)、术中体外循环时间长(OR=1.037,95％CI:1.006～1.078,P=0.034),术后辅助机械通气时间长(OR=1.094,95％CI:1.057～1.149,P＜0.001)和发生并发症(OR=14.632,95％CI:3.074～94.866,P=0.002)是术后ICU滞留风险较高的独立预测因素.在内部验证中,ROC曲线对婴幼儿法洛四联症完全矫治术后ICU滞留风险列线图的预测价值结果显示,该模型的曲线下面积为0.981(95％CI:0.965～0.998).结论 基于体重、术前中性粒细胞-淋巴细胞比值、术中体外循环时间,术后辅助机械通气时间和发生并发症构建的列线图,对婴幼儿法洛四联症完全矫治术后ICU滞留的发生风险具有较高的预测价值.
Objective To investigate the risk factors for prolonged intensive care unit(ICU)stay after complete correction of tetralogy of Fallot(TOF)in infants and young children and to construct a nomogram that predicts the risk of postoperative ICU stay.Methods A retrospective analysis was conducted on 157 children with TOF who underwent complete correction surgery at the Fuwai Central Cardiovascular Hospital Children's Heart Center from January 2021 to March 2024.The patients were divided into two groups based on whether they experienced prolonged ICU stay postoperatively:the prolonged stay group(n=40)and the non-prolonged stay group(n=117).Clinical data of the patients were collected,and the least absolute shrinkage and selection operator(LASSO)regression,univariate,and multivariate logistic regression analysis were performed to identify independent predictors of prolonged ICU stay.A nomogram was then constructed based on these predictors,and its predictive value was evaluated using the receiver operating characteristic(ROC)curve.Results Multivari-ate logistic regression analysis showed that preoperative low body weight(OR=0.607,95％CI:0.391～0.890,P=0.015),high neutrophil-lymphocyte ratio(NLR)(OR=2.499,95％CI:1.483～4.680,P＜0.001),lon-ger cardiopulmonary bypass time during surgery(OR=1.037,95％CI:1.006～1.078,P=0.034),longer du-ration of postoperative mechanical ventilation(OR=1.094,95％CI:1.057～1.149,P＜0.001),and occur-rence of complications(OR=14.632,95％CI:3.074～94.866,P=0.002)were independent predictors of prolonged ICU stay.In internal validation,the ROC curve showed that the nomogram had a good predictive per-formance for the risk of prolonged ICU stay after complete correction of TOF in infants and young children,with an area under the curve of 0.981(95％CI:0.965～0.998).Conclusions The nomogram based on body weight,preoperative NLR,cardiopulmonary bypass time,postoperative mechanical ventilation duration,and oc-currence of complications has a high predictive value for the risk of prolonged ICU stay after complete correction of TOF in infants and young children.
闫崇阳;赵力运;宋书波;梁维杰;袁心刚;李萌浩;范太兵
郑州大学华中阜外医院心外科,郑州 451464河南省人民医院阜外华中心血管病医院儿童心脏中心,郑州 451464
列线图法洛四联症完全矫治术危险因素外科手术儿童
NomogramComplete Correction of Tetralogy of FallotRisk FactorsSurgical Proce-dures,OperativeChild
《临床小儿外科杂志》 2024 (007)
620-626 / 7
河南省医学科技攻关计划项目(SBGJ202001005) Medical Science and Technology Project of Henan Province(SBGJ202001005)
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