剖宫产孕妇认知功能障碍风险预测模型的构建

doi:10.16460/j.issn1008-9969.2023.12.073

摘要/Abstract

摘要： 目的探讨剖宫产孕妇发生认知功能障碍的影响因素,构建风险预测模型。方法于2020年9月—2021年12月选取在西安市某三级甲等医院妇产科行剖宫产的孕妇212例,将其分为认知功能障碍组（n=68）和无认知功能障碍组（n=144）。采用单因素分析和二分类Logistic回归模型分析剖宫产孕妇发生认知功能障碍的影响因素,构建风险预测模型并进行内部验证。结果术后镇痛时间是剖宫产孕妇发生认知功能障碍的保护因素（OR=0.164）,顺产转剖宫产（OR=2.827）、术中失血量（OR=3.947）、焦虑/抑郁（OR=5.272）、妊娠期高血压疾病（OR=5.475）、妊娠合并糖尿病（OR=10.111）是危险因素。风险预测模型具有良好的拟合度（Hosmer-Lemeshow 检验：χ²=13.961,P=0.083）。模型内部验证显示,ROC曲线下面积为0.800,具有良好的区分度;校准曲线实际值与预测值间的平均绝对误差为0.043,具有良好的准确度;决策曲线风险阈值>0.130时,模型提供显著的临床净收益。结论剖宫产孕妇认知功能障碍风险预测模型具有科学性和实用性,能够帮助医护人员识别剖宫产孕妇发生认知功能障碍风险。

关键词: 孕妇, 剖宫产, 认知功能障碍, 影响因素, 列线图, 预测模型

Abstract: Objective To explore the influencing factors of cognitive dysfunction in pregnant women with cesarean section, and to construct a risk prediction model. Methods A total of 212 pregnant women who underwent cesarean section in the obstetrics and gynecology department of a tertiary grade-A hospital in Xi'an from September 2020 to December 2021 were enrolled and divided into cognitive dysfunction group (n=68) and non-cognitive dysfunction group (n=144). Univariate analysis and binary logistic regression were used to analyze the influencing factors of cognitive dysfunction in pregnant women with cesarean section, and a risk prediction model was constructed and verified internally. Result Postoperative analgesia time was a protective factor for cognitive dysfunction in pregnant woman with cesarean section (OR=0.164), and vaginal delivery to cesarean section (OR=2.827), intraoperative blood loss (OR=3.947), anxiety/depression (OR=5.272), gestational hypertension (OR=5.475), and gestational diabetes (OR=10.111) were risk factors. The risk prediction model had a good fit (Hosmer-Lemeshow test: χ²=13.961, P=0.083). The internal verification of the model showed that the area under the ROC curve was 0.800, which had a good degree of discrimination. The mean absolute error between the actual value and the predicted value of the calibration curve was 0.043, showing a good degree of calibration. When the risk threshold of the decision curve was greater than 0.130, the model provided significant net clinical benefit. Conclusion The risk prediction model of cognitive dysfunction in pregnant women with cesarean section is scientific and practical, which can help medical staff identify the risk of cognitive dysfunction in pregnant women with cesarean section.

Key words: pregnant women, cesarean section, cognitive dysfunction, influencing factor, nomogram, prediction model

中图分类号:

R473.71

张晓岚, 苏小花, 张敬. 剖宫产孕妇认知功能障碍风险预测模型的构建[J]. 护理学报, 2023, 30(12): 73-78.

ZHANG Xiao-lan, SU Xiao-hua, ZHANG Jing. Construction of risk prediction model for cognitive dysfunction in pregnant women with cesarean section[J]. Journal of Nursing, 2023, 30(12): 73-78.

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