广西医学

目的探讨脑肿瘤术后患者发生静脉血栓栓塞症（VTE）的危险因素，并构建列线图预测模型。方法选取880例行开颅肿瘤切除术的住院患者作为研究对象，其中616例作为建模组，264例作为验证组。记录患者VTE发生情况，收集VTE发生前的临床资料。基于建模组数据，采用多因素Logistic回归模型分析脑肿瘤术后患者发生VTE的危险因素，并根据危险因素构建风险列线图预测模型。采用受试者工作特征曲线下面积、校准曲线、决策曲线分析分别评估预测模型的区分度、校准度和临床适用性。结果 880例患者中，VTE的发生率为14.4%（127/880）。多因素 Logistic回归分析结果显示，年龄≥60岁、留置中心静脉导管、术后机械通气时间>48 h、术后下肢肌力0~3级、术后卧床时间>7 d为脑肿瘤术后患者发生VTE的独立危险因素（P<0.05），基于上述5个危险因素构建的列线图预测模型具有较好的区分度、校准度。决策曲线分析结果显示，当列线图的阈值概率为0~60%时净获益值较高。结论年龄≥60岁、留置中心静脉导管、术后机械通气时间>48 h、术后下肢肌力0~3级、术后卧床时间>7 d为脑肿瘤术后患者发生VTE的独立危险因素。基于上述危险因素构建的列线图预测模型有助于护理人员准确筛查VTE高危人群，进而采取相应的干预措施来减少VTE的发生。

Objective To explore the risk factors for the occurrence of venous thromboembolism (VTE) in patients after brain tumor surgery, and to establish a nomogram prediction model. Methods A total of 880 inpatients undergoing craniotomy of tumor were selected as the research subjects, therein 616 patients were regarded as modeling group, whereas 264 as validation group. The occurrence states of VTE in patients were recorded, and the clinical data before VTE occurrence were collected. The multivariate Logistic regression model was employed to analyze the risk factors for the occurrence of VTE in patients after brain tumor surgery based on the data from the modeling group, and the nomogram prediction model was established according to the risk factors. Area under the curve of receiver operating characteristic curve, calibration curve, and decision curve analysis were employed to evaluate the discrimination, calibration dial, and clinical applicability of the prediction model, respectively. Results The incidence rate of VTE among 880 patients was 14.4% (127/880). The results of multivariate Logistic regression analysis revealed that aged ≥60 years, central venous catheter indwelling, postoperative mechanical ventilation duration >48 hours, postoperative strength of lower limb muscles in grade 0-3, postoperative bed⁃rest time >7 days were the independent risk factors for the occurrence of VTE in patients after brain tumor surgery (P<0.05). The nomogram prediction model established based on the aforementioned 5 risk factors exerted favorable discrimination and calibration dial. The results of decision curve analysis indicated that when the threshold probability of nomogram was 0-60%, the net benefit value was relatively high. Conclusion Aged ≥60 years, central venous catheter indwelling, postoperative mechanical ventilation duration >48 hours, postoperative strength of lower limb muscles in grade 0-3, postoperative bed⁃rest time >7 days are the independent risk factors for the occurrence of VTE in patients after brain tumor surgery. The nomogram prediction model established based on the aforementioned risk factors is helpful for nursing personnel to accurately screen VTE high⁃risk population, so as to take corresponding intervention measures to reduce the occurrence of VTE.