小儿急性阑尾炎术后腹腔脓肿形成预测模型的建立与验证

摘要

探讨小儿急性阑尾炎术后腹腔脓肿（PIA）形成的独立危险因素，构建列线图预测模型并进行验证。采用回顾性队列研究设计，纳入2022年1月至2024年6月接受手术治疗的263例急性阑尾炎患儿。通过医院信息系统收集术前、术中和术后临床资料。根据PIA情况分为PIA组和非PIA组。采用LASSO回归（λ=0.021）筛选预测变量，通过多因素Logistic回归确定独立危险因素。基于回归结果构建列线图模型，通过受试者工作特征（ROC）曲线、校准曲线及Bootstrap法（1000次重抽样）评估模型的判别力、校准度及稳定性。263例患儿中，58例（22.05%）发生PIA（PIA组），205例未发生PIA（非PIA组）。与非PIA组比较，PIA组初诊至手术时间显著延长（P＜0.05），CRP、WBC、阑尾穿孔率及中重度腹腔污染比例均显著升高（P＜0.05），而ALB水平降低。多因素Logistic回归分析结果显示，初诊至手术时间延长、体温＞39.1℃、WBC升高、CRP升高、阑尾穿孔、腹腔积液、中重度腹腔污染、留置引流管为PIA独立危险因素，ALB为保护因素。基于上述9个变量构建列线图预测模型，其区分度优异（AUC=0.891，95%CI：0.841~0.941），最佳截断值为0.385，灵敏度84.5%、特异度81.5%；校准度良好，预测误差<3%。小儿急性阑尾炎术后PIA与手术延迟、全身炎症反应、营养状态及术中污染程度密切相关，基于初诊至手术时间、体温、WBC、CRP、ALB、阑尾穿孔、腹腔积液、腹腔污染、留置引流管建立的列线图预测模型可量化个体PIA风险，识别高危患儿，为临床早期预警和制定预防策略提供可靠依据。

关键词

小儿急性阑尾炎 / 术后腹腔脓肿 / 危险因素 / 列线图预测模型

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基金资助

河南省卫生健康医学研究基金项目(20230047)