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| 先天性膈疝患儿胸腔镜术后30天死亡的危险因素和列线图模型 |
| Risk factors of death within 30 days after thoracoscopic surgery in children with congenital diaphragmatic hernia and establishment of a nomogram model |
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| DOI：10.12089/jca.2024.03.006 |
| 中文关键词: 先天性膈疝 胸腔镜手术 预后 列线图 风险预测模型 校准度 |
| 英文关键词: Congenital diaphragmatic hernia Thoracoscopic surgery Prognosis Nomograph Risk prediction model Calibration degree |
| 基金项目:河北省医学科学研究课题计划（20200680） |
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| 中文摘要: |
目的：探索先天性膈疝（CDH）患儿胸腔镜术后30 d死亡的危险因素，并构建列线图风险预测模型。
方法：选择2020年6月至2023年6月接受胸腔镜膈疝修补术的CDH患儿90例，男62例，女28例，手术时日龄<28 d。根据术后30 d是否存活分为两组：生存组与死亡组。采用差异性分析、单因素Logistic回归进行预测因子筛选，采用多因素Logistic回归分析CDH胸腔镜术后30d死亡的危险因素，构建术后30 d死亡风险列线图预测模型，采用ROC曲线、Bootstrap法、决策曲线分析该模型的预测效能、校准度以及决策能力。
结果：有28例（31%）CDH患儿在胸腔镜下膈疝修补术后30 d死亡。多因素Logistic回归分析显示：产前诊断时间≤25周、低体重儿、术前高频振荡通气（HFOV）、术前氧合指数（OI）增加、开腹手术、肝脏疝入胸腔是CDH患儿术后30 d死亡的独立危险因素（P<0.05）。基于上述独立危险因素构建CDH患儿术后30 d死亡风险的列线图预测模型，结果显示，该模型AUC为0.959（95%CI 0.9107～1.0000），当截断值为0.361时，敏感性为92.9%，特异性为91.9%，约登指数为0.848，C-index为0.917，提示该模型预测能力较好；决策曲线显示，该模型的阈值概率为0.01～1.00，其净收益率>0，且均高于两条无效线。
结论：产前诊断时间≤25周、低体重儿、术前HFOV、术前OI增加、开腹手术、肝脏疝入胸腔为CDH患儿胸腔镜术后30 d死亡的独立危险因素，基于此构建的列线图预测模型对CDH患儿胸腔镜术后30 d死亡有较好预测价值。 |
| 英文摘要: |
Objective: To explore the risk factors of death within 30 days after thoracoscopic surgery in children with congenital diaphragmatic hernia (CDH), and to construct a risk nomogram prediction model.
Methods: Ninety children with congenital diaphragmatic hernia, 62 males and 28 females, the age at the time of operation < 28 days, who were treated with thoracoscopic diaphragmatic hernia repair surgery from June 2020 to June 2023 were selected. The children were divided into two groups according to whether they survived within 30 days after surgery: survival group and death group. The predictive factors were screened by difference analysis and univariate logistic regression. The risk factors of death within 30 days after thoracoscopic diaphragmatic hernia repair surgery were analyzed by multivariate logistic regression, and the risk nomogram prediction model was constructed according to the risk factors. ROC curve, bootstrap method and decision curve were used to analyze the prediction efficiency, calibration degree and decision-making ability of the model.
Results: Twenty-eight (31%) children with CDH died within 30 days after thoracoscopic diaphragmatic hernia repair surgery. Multivariate Logistic regression analysis showed that, prenatal diagnosis time ≤ 25 weeks, low birth weight infants, preoperative high-frequency oscillatory ventilation (HFOV), preoperative oxygenation index (OI), open surgery, liver hernia into the thoracic cavity was an independent risk factor of death within 30 days after surgery in children with CHD (P < 0.05). Based on the above independent risk factors, a nomogram prediction model for the risk of death in children with CDH was constructed. ROC analysis showed that the AUC of the model was 0.959 (95% CI 0.9107-1.0000). When cut-off value = 0.361, the sensitivity was 92.9%, the specificity was 91.9%, and the Youden index was 0.848. The C-index was 0.917, indicating that the model has good prediction ability. The decision-making curve showed that the threshold probability of the model ranges from 0.01 to 1.00, and its net return > 0, which was higher than the two invalid lines.
Conclusion: Prenatal diagnosis time ≤ 25 weeks, low birth weight infants, preoperative HFOV, preoperative OI increase, open surgery, liver hernia into the chest are the independent risk factors of postoperative death in children with congenital diaphragmatic hernia. The nomogram prediction model constructed based on this has good predictive value for postoperative death in children with congenital diaphragmatic hernia. |
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