輸尿管結石病人術后發生尿源性膿毒癥的風險預測模型構建及驗證

Construction and validation of a risk prediction model for postoperative urogenic sepsis in patients with ureteral calculi

ZHANG Suqiong，HE Dapeng，ZHAO Xiaoyan

Guangyuan Central Hospital，Sichuan 628000 China

Corresponding AuthorHE Dapeng，E-mail：13808127402@163.com

AbstractObjective：To construct a risk prediction model for postoperative urogenital sepsis （US） in patients with ureteral calculi based on the column-line diagram model，and to validate it.Methods：600 ureteral calculi patients admitted to our hospital from October 2017 to October 2020 were selected as the model group，and 110 ureteral calculi patients admitted to our hospital from November 2020 to July 2022 were selected as the validation group.Logistic regression analysis was used to investigate the risk factors for postoperative US，and then a line drawing risk warning model for postoperative US in ureteral calculi patients was constructed and verified for its predictive efficacy.Results：Among 600 ureteral calculi patients，50 cases had US，with an incidence rate of 8.33%.Logistic regression analysis showed that gender，history of diabetes，duration of surgery，amount of intraoperative fluid instillation，calculi size，and positive preoperative mid-stage urine culture were the risk factors for postoperative US in ureteral calculi patients （Plt;0.05）.The area under the curve （AUC） of the receiver operating characteristic of the model and validation groups were 0.910 （95%CI 0.847-0.973） and 0.885 （95%CI 0.797-0.973）.Both sets of calibration curves were well fitted to the standard curve.Conclusion：Sex，history of diabetes，operation time，intraoperative fluid volume，calculi size，and positive preoperative mid-stage urine culture are the factors influencing the occurrence of postoperative US in patients with ureteral calculi.The columnar risk warning model of postoperative US in patients with ureteral calculi constructed based on the above mentioned factors in the present study has a high clinical application value.

Keywordsureteral calculi;urogenic sepsis;risk factors；columnar diagram;nursing

摘要目的：基于列線圖模型構建輸尿管結石病人術后發生尿源性膿毒癥（US）的風險預測模型，并進行驗證。方法：選取2017年10月—2020年10月于我院收治的600例輸尿管結石病人作為模型組，2020年11月—2022年7月于我院收治的110例輸尿管結石病人作為驗證組。采用Logistic回歸分析探究其術后發生US的危險因素，然后構建輸尿管結石病人術后發生US的列線圖風險預警模型，并驗證其預測效能。結果：600例輸尿管結石病人中，50例發生US，發生率為8.33%。Logistic回歸分析結果顯示，性別、糖尿病史、手術時間、術中灌注液體量、結石大小、術前中段尿培養陽性是輸尿管結石病人術后發生US的危險因素（Plt;0.05）。模型組與驗證組的受試者工作特征曲線下面積（AUC）分別為0.910［95%CI（0.847，0.973）］和0.885［95%CI（0.797，0.973）］，兩組校正曲線均與標準曲線擬合較好。結論：性別、糖尿病史、手術時間、術中灌注液體量、結石大小、術前中段尿培養陽性是輸尿管結石病人術后發生US的影響因素，本研究基于上述因素構建的輸尿管結石病人術后發生US的列線圖風險預警模型具有較高的臨床應用價值。

關鍵詞輸尿管結石;尿源性膿毒癥;危險因素;列線圖;護理

doi：10.12102/j.issn.2095-8668.2024.16.013

尿源性膿毒癥（urinary sepsis，US）是尿路感染引起的以機體免疫功能紊亂為特點的器官功能障礙性疾病。流行病學研究顯示，膿毒癥病人中，US病人為20%～30%，總死亡率為30%～40%［1］。US多由上尿路梗阻導致，輸尿管結石是其中最常見的原因之一［2］。臨床研究發現，泌尿系統結石中，95%的病人是由于上尿路結石原因造成的，而上尿路結石中輸尿管結石與腎結石發生率高達50%［3］。……