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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 204 -209. doi: 10.3877/cma.j.issn.1674-3253.2022.03.003

临床研究

日间经皮肾镜碎石取石术患者延迟出院的危险因素分析和列线图构建
邱玲1,†(), 刘春香1, 钟文1, 陈培培2, 揭艳霞1, 何宝欣1   
  1. 1. 510230　广州医科大学附属第一医院泌尿外科
    2. 510230　广州医科大学附属第一医院普外科
  • 收稿日期:2022-03-07 出版日期:2022-06-01
  • 通信作者: 邱玲
  • 基金资助:
    2021年度国家自然科学基金项目(82170777); 2021年广州护理学会科研课题立项项目(A2021022)

Delayed discharge following day-surgery percutaneous nephrolithotomy: risk factor evaluation and nomogram construction

Ling Qiu1,†(), Chunxiang Liu1, Wen Zhong1, Peipei Chen2, Yanxia Jie1, Baoxin He1   

  1. 1. Departmend of Urology, the First Affliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
    2. Departmend of General Surgery, the First Affliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
  • Received:2022-03-07 Published:2022-06-01
  • Corresponding author: Ling Qiu
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引用本文：

邱玲, 刘春香, 钟文, 陈培培, 揭艳霞, 何宝欣. 日间经皮肾镜碎石取石术患者延迟出院的危险因素分析和列线图构建[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 204-209.

Ling Qiu, Chunxiang Liu, Wen Zhong, Peipei Chen, Yanxia Jie, Baoxin He. Delayed discharge following day-surgery percutaneous nephrolithotomy: risk factor evaluation and nomogram construction[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(03): 204-209.

目的

探讨日间经皮肾镜碎石取石术（PCNL）患者延迟出院的危险因素，并构建风险预测列线图。

方法

回顾性审查370例日间PCNL患者的电子病历，根据患者是否在24 h内出入院，将其分为延迟出院组（61例）和正常出院组（309例）。采用单因素分析比较两组的一般资料、术后1 h生命体征和血液学指标。通过Logistic回归分析确定延迟出院的危险因素，绘制列线图以预测延迟出院的风险，应用校准曲线评估列线图的内部校准性能。

结果

370例患者中有61例（16.5%）出现延迟出院，18例（4.9%）住院时间超过48 h。Logistic回归分析显示年龄>65岁（OR：3.992，95%CI：1.792~8.892，P=0.001）、通道数量（OR：3.139，95%CI：1.548~6.367，P=0.002）、术中严重出血（OR：12.207，95%CI：2.761~53.973，P=0.001）、术后1 h体温>38℃（OR：4.623，95%CI：1.445~14.789，P=0.010）、中性粒细胞比率>75%（OR：1.951，95%CI：1.008~3.777，P=0.047）和钾<3.5 mmol/L（OR：5.469，95%CI：1.641~18.226，P=0.006）是日间PCNL患者延迟出院的独立危险因素。延迟出院预测模型的ROC曲线下面积为0.784，通过危险因素构建的列线图具有良好的区分度和准确性。

结论

基于年龄、通道数量、术中严重出血、术后感染和低钾血症构建的延迟出院风险预测列线图预测性能良好，可帮助医护人员快速识别术后延迟出院高风险患者，以便尽早实施医疗干预。

关键词: 日间手术, 经皮肾镜取石术, 延迟出院, 危险因素, 列线图
Objective

To explore the risk factors of delayed discharge following day-surgery percutaneous nephrolithotomy (PCNL) and construct a risk prediction nomogram.

Methods

370 patients underwent day-surgery PCNL were retrospectively reviewed. According to whether the patients were admitted and discharged within 24 h, they were divided into delayed discharge group (n=61) and normal discharge group (n=309). Univariate analysis was used to compare the general data, vital signs and hematological indexes of the two groups. Furtherly, risk factors of delayed discharge was evaluated in multivariate logistic regression analysis. Nomogram was plotted, and calibration curve was applied to assess the internal calibration of the nomogram.

Results

61 of 370 patients (16.5%) suffered delayed discharge, 18 patients (4.9%) were hospitalized for more than 48 h. Age over 65 years (OR: 3.992, 95%CI: 1.792-8.892, P=0.001), number of tracts (OR: 3.139, 95%CI: 1.548-6.367, P=0.002), intraoperaive severe bleeding (OR: 12.207, 95%CI: 2.761-53.973, P=0.001), body temperature over 38℃(OR: 4.623, 95%CI: 1.445-14.789, P=0.010), neutrophil ratio greater than 75% (OR: 1.951, 95%CI: 1.008-3.777, P=0.047) and potassium less than 3.5 mmol/L (OR: 5.469, 95%CI: 1.641-18.226, P=0.006) were identified as independent predictors of delayed discharge following day-surgery PCNL. The area under the ROC curve of delayed discharge prediction model is 0.784, and the nomogram constructed by risk factors has good discrimination and accuracy.

Conclusion

The nomogram constructed based on age, number of channels, intraoperative severe bleeding, postoperative body temperature, neutrophil ratio, and hypokalemia has good performance in predicting the risk of delayed discharge. It can help medical staff quickly identify high-risk patients with delayed discharge, so that medical intervention can be implemented as soon as possible.

Key words: Day-surgery, Percutaneous nephrolithotomy, Delayed discharge, Risk factor, Nomogram
表1 两组PCNL患者的一般资料比较
项目 例数 性别(例) 年龄>65岁(例) BMI值[kg/m2，(±s)] 主要取石部位(例) 结石大小[mm，(±s)] 结石类型(例) 主要结石成分(例)
男 女 左 右 单个 多发 鹿角形 草酸钙 碳酸磷灰石 尿酸或其他
DD组 061 039 022 16 24.0±4.1 036 025 21.2±8.8 024 032 05 047 06 08
ND组 309 193 116 24 23.8±3.6 170 139 20.5±8.6 128 160 21 229 35 45
统计值   χ2=0.047 χ2=13.370 t=0.397 χ2=0.330 t=0.555 χ2=0.200 χ2=2.726
P值   0.828 <0.001 0.693 0.565 0.581 0.905 0.256
项目 穿刺部位(例) 通道数量(例) 肾造瘘管数量(例) 手术时间>120 min(例) 术中严重出血b(例) 基础疾病(例)
上盏 中盏 下盏 多个肾盏穿刺a 单通道 多通道 无管 1条 2条或以上 高血压 糖尿病 心功能不全 肾功能不全
DD组 6 039 08 08 037 24 023 028 10 06 8 14 05 04 07
ND组 53 173 58 25 270 39 139 140 30 10 4 40 18 10 11
统计值 χ2=4.627 χ2=25.750 χ2=2.726 χ2=3.887 χ2=19.072 χ2=4.092 χ2=0.491 χ2=1.543 χ2=5.292
P值 0.201 <0.001 0.256 0.049 <0.001 0.043 0.483 0.214 0.021
表2 两组PCNL患者术后1 h生命体征和血液学指标比较（例）
项目 DD组 ND组 χ2值 P值
例数 61 309    
T>38℃ 9 7 16.3050 <0.0010
P<50 or >110 min-1 4 9 1.805 0.179
B<12 or >24 min-1 5 10 2.074 0.150
SBP<80 or >160 mmHg 6 9 4.624 0.032
DBP<50 or >100 mmHg 6 13 2.259 0.133
WBC<4 or >12×109/L 18 73 0.951 0.329
NEUT%>75% 29 76 13.1960 <0.0010
RBC<4×1012/L 13 53 0.601 0.438
Hb<90 g/L 7 12 4.570 0.033
PLT<100 or >300×109/L 2 23 0.819 0.365
GLU<3.9 or >6.1 mmol/L 10 27 3.317 0.069
BUN>7.2 mmol/L 10 32 1.845 0.174
SCr>133 umol/L 14 44 2.925 0.087
K<3.5 mmol/L 8 7 12.7530 <0.0010
Na<134 or >145 mmol/L 2 18 0.244 0.621
Cl<96 or>111 mmol/L 9 28 1.834 0.176
CO2CP<21 or >29 mmol/L 8 23 2.135 0.144
Ca<2 or >2.70 mmol/L 9 19 4.233 0.040
PT>14.5 s 3 9 0.166 0.683
APTT>42.8 s 5 14 0.555 0.456
FIB<2 or >4 g/L 12 57 0.080 0.778
DD（XS）>0.5 ug/ml 7 32 0.068 0.795
图3 日间PCNL患者延迟出院风险预测列线图的内部校准曲线
表3 日间PCNL患者延迟出院的Logistic回归分析
变量 β 标准误 Wald χ2 P值 OR（95%CI）
年龄>65岁 1.384 0.409 11.477 0.001 3.992(1.792~8.892)
通道数量 1.144 0.361 10.054 0.002 3.139(1.548~6.367)
术中严重出血 2.502 0.758 10.882 0.001 12.207(2.761~53.973)
T>38℃ 1.531 0.593 06.660 0.010 04.623(1.445~14.789)
NEUT%>75% 0.668 0.337 03.930 0.047 1.951(1.008~3.777)
K<3.5 mmol/L 1.699 0.614 07.654 0.006 05.469(1.641~18.226)
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