急诊手术腹部正中切口术后切口并发症的相关危险因素分析

doi:10.16139/j.1007-9610.2020.03.013

摘要/Abstract

摘要：

目的:本研究旨在建立一个预测列线图,以预测普外科急诊手术病人腹部正中切口发生切口相关并发症的风险。方法:收集247例就诊于本院外科急诊手术病人的临床资料,分为切口并发症组68例,无切口并发症组139例。用LASSO（least absolute shrinkage and selection operator）回归分析以筛选风险预测指标。对纳入的指标进行多元Logistic回归,以量化预测模型。C指数和校正曲线来评估模型的判别能力及准确性。结果:年龄（≥60岁）、吸烟、腹部手术史、术前低白蛋白血症、C反应蛋白升高及腹部间断+连续缝合方式6个指标纳入预测模型。此模型的C指数为0.747（95% CI: 0.678~0.816）,说明该模型具有良好的判别能力和准确性。结论:该列线图可用于预测普外科急诊手术病人腹部正中切口发生切口相关并发症的风险。

关键词: 急诊, 腹部手术, 切口并发症, 列线图

Abstract:

Objective To establish the nomogram and predict the risk factors of wound complication in patients with emergent abdominal surgery via a midline vertical incision. Methods The clinical data of 247 patients treated in Department of Surgery Ruijin Hospital including 68 cases with wound complication and 139 cases without wound complication were collected and analyzed. Risk predictors were selected from the items of clinical strategies by the least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis was performed with incorporated items. C-index and calibration plot were used to evaluate the discrimination and calibration of prediction model. Results Six items including age ≥60 years, smoking and history of abdominal surgery, preoperative lower albumin in serum and increase in C-reactive protein level, and both continuous and interrupted suture of abdominal incision were included in the prediction model. The prediction model showed better discrimination and calibration with a C-index of 0.747 (95%Cl: 0.678-0.816). Conclusions The established nomogram can be used to predict the risk of wound complication in patients with emergent abdominal surgery via abdominal midline vertical incision.

Key words: Emergency, Abdominal surgery, Wound complication, Nomogram

中图分类号:

R656.1

於平, 王越, 翟述昱, 王晓彦, 黄梁, 毛恩强. 急诊手术腹部正中切口术后切口并发症的相关危险因素分析[J]. 外科理论与实践, 2020, 25(03): 239-244.

YU Ping, WANG Yue, ZHAI Shuyu, WANG Xiaoyan, HUANG Liang, MAO Enqiang. Analysis of risk factors of wound complication after emergent surgery via a midline vertical incision[J]. Journal of Surgery Concepts & Practice, 2020, 25(03): 239-244.

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指标	总计(n=247)	有切口并发症(n=68)	无切口并发症(n=179)	χ²	P值
年龄（岁）
≥60	115	47 (40.87%)	68	19.191 7	<0.000 1
<60	132	21 (15.91%)	111
性别
男	168	49 (29.17%)	119	0.704 9	0.401
女	79	19 (24.05%)	60
BMI
>24	48	13 (27.08%)	35	0.128 9	0.720
≤24	199	55 (27.63%)	144
糖尿病史
有	46	14 (30.43%)	32	0.239 0	0.625
无	201	54 (26.87%)	147
高血压史
有	47	15 (31.91%)	32	0.559 3	0.455
无	200	53 (26.50%)	147
心脑肾疾病史
有	46	15 (32.61%)	31	0.730 7	0.393
无	201	53 (26.37%)	148
吸烟史
是	60	22 (36.67%)	38	3.315 7	0.069
否	187	46 (24.60%)	141
喝酒史
是	76	20 (26.32%)	56	0.081 2	0.776
否	171	48 (28.07%)	123
腹部手术史
有	37	9 (24.32%)	28	0.224 2	0.636
无	210	59 (28.10%)	151
术前贫血
是	40	10 (25.00%)	30	0.153 2	0.696
否	207	58 (28.02%)	149
术前低白蛋白血症（<30 g/L）
是	48	20 (41.67%)	28	5.967 4	0.015
否	199	48 (24.12%)	151
术前电解质异常
是	54	15 (27.78%)	39	0.002 1	0.963
否	193	53 (27.46%)	140
术前生化指标异常
是	46	14 (30.43%)	32	0.239 0	0.625
否	201	54 (26.87%)	147
C反应蛋白升高(>40 mg/L)
是	81	20 (24.69%)	61	0.486 9	0.485
否	166	48 (28.92%)	118
腹部缝合方式
连续缝合	85	30 (35.29%)	55	19.538 1	<0.000 1
间断缝合	80	30 (37.50%)	50
间断+连续缝合	82	8 (9.76%)	74

指标	β值	OR(95%CI)	P值
高龄（≥60岁）	1.0442	2.841 (1.459-5.691)	0.003
吸烟史	0.5660	1.761 (0.820-3.785)	0.145
腹部手术史	-0.5981	0.550 (0.206-1.371)	0.212
术前低白蛋白血症（<30 g/L）	0.6216	1.862 (0.827-4.224)	0.133
C反应蛋白升高(>40 mg/L)	-0.6589	0.517 (0.239-1.075)	0.084
腹部缝合方式 (间断缝合)	0.1666	1.181 (0.502-2.781)	0.702
腹部缝合方式 (间断+连续缝合)	-1.4395	0.237 (0.082-0.636)	0.005