口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (8): 564-570.DOI: 10.12016/j.issn.2096-1456.2022.08.005
收稿日期:
2021-09-10
修回日期:
2021-11-29
出版日期:
2022-08-20
发布日期:
2022-05-09
通讯作者:
何杏芳
作者简介:
朱惠璇,护师,学士,Email: 548897851@qq.com
基金资助:
ZHU Huixuan(), HE Xingfang(
), HUANG Qiuyu, LIU Manfeng, LIN Yantong
Received:
2021-09-10
Revised:
2021-11-29
Online:
2022-08-20
Published:
2022-05-09
Contact:
HE Xingfang
Supported by:
摘要:
目的 了解口腔颌面恶性肿瘤患者术后便秘发生情况与便秘影响因素,构建便秘风险预测模型,为防治术后便秘提供参考。方法 回顾性分析2019年6月至2020年6月在中山大学附属口腔医院行口腔颌面恶性肿瘤手术的191例患者资料,采用单因素分析和Logistic多因素回归分析筛选出独立影响因素,建立风险预测列线图,采用ROC曲线下面积对预测模型进行评价。内部和外部均采用C指数验证该模型的准确度。结果 191例患者中有52例(27.23%)术后出现便秘症状。单因素分析显示,术前便秘史、进食能全素、气管切开、吸烟、喝酒、手术时长、出血量、卧床时间、进食匀浆膳、性别、手术修补方式、使用益生菌、癌症T分期、进食量均可能是口腔颌面恶性肿瘤患者术后便秘的影响因素(P<0.05)。多因素分析结果显示,修补方式、卧床时间、性别是口腔颌面恶性肿瘤患者术后便秘的独立危险因素(P<0.05),修补方式为腓骨瓣、卧床时间长、男性患者术后易出现便秘。将修补方式、卧床时间、性别纳入预测模型中,训练组和验证组的C指数值分别为0.882和0.953;训练组的ROC曲线下面积为0.909(95%CI: 0.850 ~ 0.968),验证组的ROC曲线下面积为0.893(95%CI: 0.787 ~ 0.999),列线图显示出良好的鉴别能力。结论 修补方式、卧床时间、性别是口腔颌面恶性肿瘤患者术后便秘的独立危险因素,构建的风险预测模型有较好的判别能力。
中图分类号:
朱惠璇, 何杏芳, 黄秋雨, 刘满凤, 林艳彤. 口腔颌面恶性肿瘤患者术后发生便秘风险预测模型构建[J]. 口腔疾病防治, 2022, 30(8): 564-570.
ZHU Huixuan, HE Xingfang, HUANG Qiuyu, LIU Manfeng, LIN Yantong. Establishment of a risk prediction model for postoperative constipation in patients with oral and maxillofacial malignant tumors[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(8): 564-570.
No constipation group(n=139) | Constipation group(n=52) | χ2/t | P | |
---|---|---|---|---|
Sex | ||||
Male | 72 | 40 | 9.949 | 0.002 |
Female | 67 | 12 | ||
Smoke | ||||
No | 103 | 28 | 7.206 | 0.007 |
Yes | 36 | 24 | ||
Drink | ||||
No | 117 | 37 | 4.107 | 0.043 |
Yes | 22 | 15 | ||
Constipation before surgery | ||||
No | 133 | 45 | 4.989 | 0.026 |
Yes | 6 | 7 | ||
Intake of total nutrients | ||||
No | 38 | 2 | 11.235 | 0.001 |
Yes | 101 | 50 | ||
Tracheotomy | ||||
No | 116 | 16 | 49.202 | <0.001 |
Yes | 23 | 36 | ||
Operation duration/h | 3.17 ± 2.81 | 6.75 ± 3.18 | -7.555 | <0.001 |
Amount of bleeding/mL | 193.60 ± 273.00 | 472.02 ± 404.19 | -4.591 | <0.001 |
Time in bed/day | 2.34 ± 2.39 | 7.31 ± 3.13 | -11.648 | <0.001 |
Eat homogenate meals/(sub/day) | 3.04 ± 0.48 | 2.65 ± 0.62 | 4.079 | <0.001 |
Food-intake/mL | 1 471.94 ± 267.58 | 1 694.12 ± 214.86 | -5.895 | <0.001 |
Surgical repair method | ||||
Anterolateral thigh flap | 8 | 17 | 54.685 | <0.001 |
Fibula flap | 1 | 8 | ||
Forearm flap | 13 | 10 | ||
Other flap | 12 | 4 | ||
No | 105 | 13 | ||
Use of probiotics | ||||
No | 95 | 11 | 34.124 | <0.001 |
Yes | 44 | 41 | ||
The T stage of cancer pain | ||||
1-2 | 119 | 21 | 39.550 | <0.001 |
3-4 | 20 | 31 |
表1 口腔颌面恶性肿瘤患者术后便秘影响因素的单因素分析
Table 1 Univariate analysis of the factors influencing postoperative constipation in patients with oral and maxillofacial malignancies
No constipation group(n=139) | Constipation group(n=52) | χ2/t | P | |
---|---|---|---|---|
Sex | ||||
Male | 72 | 40 | 9.949 | 0.002 |
Female | 67 | 12 | ||
Smoke | ||||
No | 103 | 28 | 7.206 | 0.007 |
Yes | 36 | 24 | ||
Drink | ||||
No | 117 | 37 | 4.107 | 0.043 |
Yes | 22 | 15 | ||
Constipation before surgery | ||||
No | 133 | 45 | 4.989 | 0.026 |
Yes | 6 | 7 | ||
Intake of total nutrients | ||||
No | 38 | 2 | 11.235 | 0.001 |
Yes | 101 | 50 | ||
Tracheotomy | ||||
No | 116 | 16 | 49.202 | <0.001 |
Yes | 23 | 36 | ||
Operation duration/h | 3.17 ± 2.81 | 6.75 ± 3.18 | -7.555 | <0.001 |
Amount of bleeding/mL | 193.60 ± 273.00 | 472.02 ± 404.19 | -4.591 | <0.001 |
Time in bed/day | 2.34 ± 2.39 | 7.31 ± 3.13 | -11.648 | <0.001 |
Eat homogenate meals/(sub/day) | 3.04 ± 0.48 | 2.65 ± 0.62 | 4.079 | <0.001 |
Food-intake/mL | 1 471.94 ± 267.58 | 1 694.12 ± 214.86 | -5.895 | <0.001 |
Surgical repair method | ||||
Anterolateral thigh flap | 8 | 17 | 54.685 | <0.001 |
Fibula flap | 1 | 8 | ||
Forearm flap | 13 | 10 | ||
Other flap | 12 | 4 | ||
No | 105 | 13 | ||
Use of probiotics | ||||
No | 95 | 11 | 34.124 | <0.001 |
Yes | 44 | 41 | ||
The T stage of cancer pain | ||||
1-2 | 119 | 21 | 39.550 | <0.001 |
3-4 | 20 | 31 |
Variable | β | SE | Wald | P | OR | 95%CI |
---|---|---|---|---|---|---|
Sex | -1.595 | 0.643 | 6.162 | 0.013 | 0.203 | 0.058-0.715 |
Time in bed | 0.608 | 0.153 | 15.822 | <0.001 | 1.837 | 1.361-2.479 |
Surgical repair method | 8.297 | 0.081 | ||||
Anterolateral thigh flap | 1.128 | 1.296 | 0.757 | 0.384 | 3.090 | 0.243-39.210 |
Fibula flap | 4.263 | 1.646 | 6.709 | 0.010 | 71.011 | 2.821-1 787.267 |
Forearm flap | 0.430 | 1.284 | 0.112 | 0.738 | 1.537 | 0.124-19.038 |
Other flap | 0.607 | 1.482 | 0.168 | 0.682 | 1.835 | 0.101-33.502 |
Constants | -18.967 | 13 820.377 | 0.000 | 0.999 | 0.000 |
表2 口腔颌面恶性肿瘤患者术后便秘影响因素的二元logistic回归分析
Table 2 Binary logistic regression analysis of influencing factors of postoperative constipation in patients with oral and maxillofacial malignant tumors
Variable | β | SE | Wald | P | OR | 95%CI |
---|---|---|---|---|---|---|
Sex | -1.595 | 0.643 | 6.162 | 0.013 | 0.203 | 0.058-0.715 |
Time in bed | 0.608 | 0.153 | 15.822 | <0.001 | 1.837 | 1.361-2.479 |
Surgical repair method | 8.297 | 0.081 | ||||
Anterolateral thigh flap | 1.128 | 1.296 | 0.757 | 0.384 | 3.090 | 0.243-39.210 |
Fibula flap | 4.263 | 1.646 | 6.709 | 0.010 | 71.011 | 2.821-1 787.267 |
Forearm flap | 0.430 | 1.284 | 0.112 | 0.738 | 1.537 | 0.124-19.038 |
Other flap | 0.607 | 1.482 | 0.168 | 0.682 | 1.835 | 0.101-33.502 |
Constants | -18.967 | 13 820.377 | 0.000 | 0.999 | 0.000 |
图1 预测便秘的列线图
Figure 1 Nomogram for predicting constipation Gender (1= male, 2= female), fibula flap (0= nonfibula flap, 1= fibula flap), time in bed by days (1 to 15 days)
图2 训练组的列线图校准曲线
Figure 2 Calibration curve for the nomogram training group The standard curve is a straight line passing through the origin of the coordinate axis with a slope of 1. The closer the predicted calibration curve is to the standard curve, the better the predictive power of the nomogram
图3 验证组的列线图校准曲线
Figure 3 Calibration curve of the nomogram validation group The calibrated curve is close to the diagonal, that is, the gap between the predicted value and the real value is small, and the prediction performance of the model is good
图4 训练组口腔颌面恶性肿瘤患者术后便秘风险预测的ROC曲线
Figure 4 ROC curve of predicting the risk of postoperative constipation in patients with oral and maxillofacial malignant tumors in the training group On the ROC curve, the point near the upper left of the coordinate map is the high cutoff value for both sensitivity and specificity. The sensitivity is drawn as the vertical coordinates and (1-specificity) as the horizontal coordinates, and the larger the area under the curve is, the higher the diagnostic accuracy.
图5 验证组口腔颌面恶性肿瘤患者术后便秘风险预测的ROC曲线
Figure 5 ROC curve of predicting the risk of postoperative constipation in patients with oral and maxillofacial malignant tumors in the validation group On the ROC curve, the point near the top left of the coordinate map has high cutoff values for both sensitivity and specificity, showing the excellent discrimination effect of this model for patients with constipation
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