成人小肠梗死预测的多因素Logistic回归分析及模型建立

发布时间：2018-06-28 01:17

  本文选题：肠梗死 + 多因素分析　； 参考：《青岛大学》2014年硕士论文

【摘要】：目的：探讨预测成人小肠梗死发生与否的主要危险因素,建立Logistic回归模型,评价其预测小肠梗死发生的准确度、敏感度和特异度,为临床及时手术治疗提供依据。 方法：回顾性分析青岛大学附属医院2007年1月至2014年1月收治的392例患者资料,其中186例小肠梗死患者作为研究组；206例存在腹部手术史的粘连性小肠梗阻患者作为对照组(全部经手术治疗并排除肠梗死)。对患者的临床表现、影像学资料和实验室检查结果等指标进行单因素分析,取存在统计学意义的变量行多因素Logistic回归分析,判断预测因子是否与小肠梗死的诊断有关,并建立Logistic回归预测模型,评价其预测小肠梗死发生的准确度、敏感度和特异度。 结果：患者高热(T38.5℃)、腹部手术史、腹膜刺激征、反复发作、黑便或便血、肠壁增厚、肠系膜水肿、白细胞计数、术前血pH值、乳酸水平、血肌酐、血尿素氮、术前肌酸激酶水平、术前CRP水平14个危险因素与预测肠梗死的发生与否密切相关。经多因素Logistic回归分析显示,有8个因素进入方程,根据OR值大小判定其作用强弱依次为：黑便或便血、腹膜刺激征、肌酸激酶、C-反应蛋白、血肌酐、肠系膜水肿、高热、术前白细胞水平。得到成人肠梗死判定的多因素Logistic回归预测模型为：P=1/(1+e (-2.365+2.366X1+2.144X2+1.795X3+1.762X4+1.541X5+0.583X6+0.540X7+0.450X8))。预测小肠梗死是否发生的准确度为81.12%,敏感度为75.27%,特异度为86.41%。 结论对于怀疑发生小肠梗死的病人,黑便或便血、腹膜刺激征、肌酸激酶、C-反应蛋白、血肌酐、肠系膜水肿、高热、术前白细胞水平可作为预测小肠梗死发生与否的主要危险因素,所建立的Logistic回归模型能较好地判断有无成人小肠梗死的发生。
[Abstract]:Objective: to explore the main risk factors for predicting the occurrence of small intestinal infarction in adults, to establish logistic regression model, to evaluate its accuracy, sensitivity and specificity in predicting the occurrence of small intestinal infarction, and to provide the basis for clinical timely surgical treatment. Methods: the data of 392 patients admitted from January 2007 to January 2014 in affiliated Hospital of Qingdao University were analyzed retrospectively. 186 cases of small intestinal infarction were used as study group. 206 cases of adherent intestinal obstruction with history of abdominal surgery were used as control group (all patients were treated surgically and intestinal infarction was excluded). The clinical manifestations, imaging data and laboratory results were analyzed by univariate analysis. The variables with statistical significance were analyzed by multivariate logistic regression analysis to determine whether the predictor was related to the diagnosis of small intestinal infarction. Logistic regression model was established to evaluate the accuracy, sensitivity and specificity of predicting small intestinal infarction. Results: patients with high fever (T38.5 鈩，

本文编号：2076070