儿童先天性心脏病手术后重症肺炎的风险预测研究

任春年; 吴春; 潘征夏; 李勇刚

doi:10.16016/j.1000-5404.202007232

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儿童先天性心脏病手术后重症肺炎的风险预测研究

心脏外科临床研究 | 更新时间：2026-01-09

- 儿童先天性心脏病手术后重症肺炎的风险预测研究
- Risk prediction for severe pneumonia following congenital heart disease surgery in children
- 第三军医大学学报 2021年43卷第2期页码：109-116
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胸心外科，儿童发育疾病研究教育部重点实验室
- 作者简介：
  
  [ 李勇刚，E-mail: yulyg@sina.com LI Yonggang, E-mail: yulyg@sina.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202007232
  中图分类号： R541.1;R619;R725.631
- 收稿：2020-07-29，
  
  修回：2020-10-25，
  
  纸质出版：2021-01-30
- 稿件说明：
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任春年, 吴春, 潘征夏, 等. 儿童先天性心脏病手术后重症肺炎的风险预测研究[J]. 第三军医大学学报, 2021,43(2):109-116.

Chunnian REN, Chun WU, Zhengxia PAN, et al. Risk prediction for severe pneumonia following congenital heart disease surgery in children[J]. Journal of Third Military Medical University, 2021, 43(2): 109-116.
任春年, 吴春, 潘征夏, 等. 儿童先天性心脏病手术后重症肺炎的风险预测研究[J]. 第三军医大学学报, 2021,43(2):109-116. DOI： 10.16016/j.1000-5404.202007232.

Chunnian REN, Chun WU, Zhengxia PAN, et al. Risk prediction for severe pneumonia following congenital heart disease surgery in children[J]. Journal of Third Military Medical University, 2021, 43(2): 109-116. DOI： 10.16016/j.1000-5404.202007232.

摘要

目的

建立并验证儿童先天性心脏病体外循环手术后发生重症肺炎的风险预测模型。

方法

将2014年10月至2017年12月于重庆医科大学附属儿童医院胸心外科确诊为先心病并接受体外循环下手术治疗的患者纳入建模组(

=1 415)，将2017年12月至2018年10月接受体外循环手术的患者纳入验证组(

=393)。采用单因素和多因素Logistic回归分析筛选体外循环术后发生重症肺炎的独立危险因素。根据回归系数建立相应的列线图。用受试者工作特征曲线(ROC)下的面积(AUC)及校准曲线来评价模型。

结果

单因素和多因素Logistic回归分析发现:年龄、体质量、术前住院时间、先天性心脏手术风险调整分级(RACHS-1评分)、体外循环时间是影响体外循环手术后重症肺炎的5个独立危险因素。根据5个独立危险因素，建立个体化预测模型。模型评价结果显示:建模组和验证组的AUC分别为0.943(95%

，0.929-0.954)和0.925(95%

，0.894-0.949)，校准试验的

值分别为0.592和0.256。

结论

本研究建立的个体化预测模型可较好地应用于评估先天性心脏病患儿体外循环术后发生重症肺炎的风险。

Abstract

Objective

To establish and validate a risk prediction model for severe pneumonia following cardiopulmonary bypass (CPB) in children with congenital heart disease.

Methods

All the children diagnosed with congenital heart disease and treated with CPB surgery in the Department of Thoracic Surgery

Children's hospital of Chongqing Medical University from October 2014 to December 2017 were assigned into the modeling group (

=1 415)

while those treated from December 2017 to October 2018 were enrolled into the validation group (

=393). The independent risk factors for severe pneumonia after surgery were screened using univariate and multivariate Logistic regression analysis

and the corresponding nomogram prediction model was constructed according to the regression coefficients. The receiver operating characteristic (ROC) curve and calibration curve were used respectively to evaluate the discriminant validity and calibration of the prediction model.

Results

The following 5 indicators were revealed to be the independent risk factors for severe pneumonia after CPB surgery: age

weight

preoperative hospital stay

score of Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) and time of cardiopulmonary bypass. Based on them

an individualized prediction model was established. The area under the curve (AUC) of the prediction model was 0.943 (95%

: 0.929-0.954) and 0.925 (95%

: 0.894-0.949) for the modeling and validation groups

indicating good discriminant validity. The

value of the calibration test was 0.592 and 0.256 for the 2 groups.

Conclusion

Our established individualized prediction model can be well used to evaluate the risk of severe pneumonia in children with congenital heart disease after CPB.

关键词

Keywords

references

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