摘要
目的探讨经自然腔道内镜手术(NOTES)保胆取石(息肉)术后患者并发症的发生风险及有效护理对策。方法回顾性分析行NOTES保胆取石(息肉)术的108例患者的临床资料,按近似4∶1的比例将患者随机分为建模组(n=88)和验证组(n=20),根据术后是否出现并发症将建模组分为非术后并发症组(n=46)和术后并发症组(n=42)。比较非术后并发症组患者和术后并发症组患者的临床资料,采用多因素Logistic回归模型分析患者术后出现并发症的影响因素,并构建预测模型。采用受试者工作特征(ROC)曲线评估预测模型的预测效能,采用验证组的数据对预测模型进行验证。在此基础上,提出针对NOTES保胆取石(息肉)术后患者的有效护理对策。结果88例建模组患者中,42例患者(47.73%)出现术后并发症。两组患者的体质指数、术前C反应蛋白(CRP)水平、术前降钙素原水平和凝血功能异常比例比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前CRP水平升高、术前降钙素原水平升高和凝血功能异常是NOTES保胆取石(息肉)术后患者出现并发症的独立危险因素(P<0.05),基于危险因素建立的预测模型为logit(P)=1.223+0.022×术前CRP+0.159×术前降钙素原+1.561×凝血功能异常。采用该模型预测NOTES保胆取石(息肉)术后患者并发症发生风险的曲线下面积为0.823,预测准确率为80.00%,预测价值较高。该预测模型计算结果>52.189者为NOTES保胆取石(息肉)术后发生并发症的高危人群。结论术前CRP水平升高、术前降钙素原水平升高和凝血功能异常是NOTES保胆取石(息肉)术后患者出现并发症的独立危险因素。基于上述因素构建的预测模型计算结果>52.189者为NOTES保胆取石(息肉)术后发生并发症的高危人群,对于这类患者应及时采取相应的护理措施,以减少其术后并发症的发生。
Objective To explore the risk and effective nursing countermeasure of patients suffering from complications after gallbladder-preserving lithotomy(polyps resection)via natural orifice transluminal endoscopic surgery(NOTES).Methods The clinical data of 108 patients undergoing NOTES gallbladder-preserving lithotomy(polyps resection)were retrospectively analyzed.Patients were randomly assigned to modeling group(n=88)or verification group(n=20)according to the approximate ratio of 4∶1,and patients in the modeling group were further divided into non-postoperative complications group(n=46)or postoperative complications group(n=42)according to the presence of postoperative complications occurred.The clinical data were compared between the non-postoperative complications group and the postoperative complications group.The multivariate Logistic regression model was used to analyze the influencing factors for patients suffering from postoperative complications,and the prediction model was established.The receiver operating characteristic(ROC)curve was used to evaluate the prediction efficiency of the prediction model,and the data from the validation group was employed to performed validation on the prediction model,based on which effective nursing countermeasure was put forward to patients after NOTES gallbladder-preserving lithotomy(polyps resection).Results Among 88 patients in the modeling group,42(47.73%)patients suffered from postoperative complications.There were statistically significant differences in body mass index,preoperative C-reactive protein(CRP)level,preoperative procalcitonin level,and proportion of abnormal coagulation function between the two groups(P<0.05).The results of multivariate Logistic regression analysis revealed that the elevations of preoperative CRP and procalcitonin levels,as well as abnormal coagulation function were independent risk factors for patients suffering from postoperative complications after NOTES gallbladder-preserving lithotomy(polyps resection)(P<0.05),and the prediction model established based on the aforementioned risk factors was logit(P)=1.223+0.022×preoperative CRP+0.159×preoperative procalcitonin+1.561×abnormal coagulation function.Areas under the curve of this model for predicting patients suffering from postoperative complications after NOTES gallbladder-preserving lithotomy(polyps resection)was 0.823,accuracy rate was 80.00%,exerting a relatively high predictive value.Patients with calculation of this prediction model larger than 52.189 were the high-risk population for the occurrence of postoperative complications after NOTES gallbladder-preserving lithotomy(polyps resection).Conclusion The elevations of preoperative CRP and procalcitonin levels,and abnormal coagulation function are independent risk factors for patients suffering from postoperative complications after NOTES gallbladder-preserving lithotomy(polyps resection).Patients with calculation of the prediction model established based on the aforementioned factors larger than 52.189 are the high-risk population who suffer from postoperative complications after NOTES gallbladder-preserving lithotomy(polyps resection),for this population,corresponding nursing countermeasures should be taken in time to reduce the occurrence of postoperative complications.
作者
温慧萍
马桂芳
潘燕华
温春虹
唐庆林
邓立新
吕新芝
黄雪娟
WEN Huiping;MA Guifang;PAN Yanhua;WEN Chunhong;TANG Qinglin;DENG Lixin;LYU Xinzhi;HUANG Xuejuan(Department of Gastroenterology,No.909 Hospital of the Chinese People′s Liberation Army Joint Logistic Support Force/Dongnan Hospital Affiliated to Xiamen University,Zhangzhou 363000,Fujian,China;Inpatient Ward of Cadre Ward,No.909 Hospital of the Chinese People′s Liberation Army Joint Logistic Support Force/Dongnan Hospital Affiliated to Xiamen University,Zhangzhou 363000,Fujian,China;Department of Neurology,No.909 Hospital of the Chinese People′s Liberation Army Joint Logistic Support Force/Dongnan Hospital Affiliated to Xiamen University,Zhangzhou 363000,Fujian,China)
出处
《广西医学》
CAS
2023年第20期2436-2441,共6页
Guangxi Medical Journal
基金
漳州市科技计划项目(ZZ2021J25)
第九〇九医院院级科研项目(20YJ002)。
关键词
胆囊结石
胆囊息肉
经自然腔道内镜手术
并发症
护理
预测模型
Cholecystolithiasis
Gallbladder polyps
Natural orifice transluminal endoscopic surgery
Complications
Nursing
Prediction model
