本文選題：腸梗死 + 多因素分析�。� 參考：《青島大學(xué)》2014年碩士論文

【摘要】：目的：探討預(yù)測成人小腸梗死發(fā)生與否的主要危險(xiǎn)因素,建立Logistic回歸模型,評價(jià)其預(yù)測小腸梗死發(fā)生的準(zhǔn)確度、敏感度和特異度,為臨床及時手術(shù)治療提供依據(jù)。 方法：回顧性分析青島大學(xué)附屬醫(yī)院2007年1月至2014年1月收治的392例患者資料,其中186例小腸梗死患者作為研究組；206例存在腹部手術(shù)史的粘連性小腸梗阻患者作為對照組(全部經(jīng)手術(shù)治療并排除腸梗死)。對患者的臨床表現(xiàn)、影像學(xué)資料和實(shí)驗(yàn)室檢查結(jié)果等指標(biāo)進(jìn)行單因素分析,取存在統(tǒng)計(jì)學(xué)意義的變量行多因素Logistic回歸分析,判斷預(yù)測因子是否與小腸梗死的診斷有關(guān),并建立Logistic回歸預(yù)測模型,評價(jià)其預(yù)測小腸梗死發(fā)生的準(zhǔn)確度、敏感度和特異度。 結(jié)果：患者高熱(T38.5℃)、腹部手術(shù)史、腹膜刺激征、反復(fù)發(fā)作、黑便或便血、腸壁增厚、腸系膜水腫、白細(xì)胞計(jì)數(shù)、術(shù)前血pH值、乳酸水平、血肌酐、血尿素氮、術(shù)前肌酸激酶水平、術(shù)前CRP水平14個危險(xiǎn)因素與預(yù)測腸梗死的發(fā)生與否密切相關(guān)。經(jīng)多因素Logistic回歸分析顯示,有8個因素進(jìn)入方程,根據(jù)OR值大小判定其作用強(qiáng)弱依次為：黑便或便血、腹膜刺激征、肌酸激酶、C-反應(yīng)蛋白、血肌酐、腸系膜水腫、高熱、術(shù)前白細(xì)胞水平。得到成人腸梗死判定的多因素Logistic回歸預(yù)測模型為：P=1/(1+e (-2.365+2.366X1+2.144X2+1.795X3+1.762X4+1.541X5+0.583X6+0.540X7+0.450X8))。預(yù)測小腸梗死是否發(fā)生的準(zhǔn)確度為81.12%,敏感度為75.27%,特異度為86.41%。 結(jié)論對于懷疑發(fā)生小腸梗死的病人,黑便或便血、腹膜刺激征、肌酸激酶、C-反應(yīng)蛋白、血肌酐、腸系膜水腫、高熱、術(shù)前白細(xì)胞水平可作為預(yù)測小腸梗死發(fā)生與否的主要危險(xiǎn)因素,所建立的Logistic回歸模型能較好地判斷有無成人小腸梗死的發(fā)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，

本文編號：2076069