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目的 探讨肝细胞癌患者肝切除术中发生大出血的危险因素，并构建风险预警模型且验证。方法 选取2021年3月至2023年10月在某医院接受肝切除术的186例肝细胞癌患者作为模型组，根据术中有无发生大出血分为出血组(n=33)和非出血组(n=153)。采用单因素分析、多因素Logistic回归分析影响因素，并构建预测模型。另选取79例接受肝切除术的肝细胞癌患者作为验证组。结果 模型组的肝细胞癌患者肝切除术中大出血发生率为17.74%(33/186)。多因素分析结果显示，肿瘤直径>5.0 cm、术前血小板计数<100×109/L、手术时间≥5 h、肿瘤位置在肝右后叶下腔静脉、肝切除范围较大均是肝细胞癌患者肝切除术中大出血的独立危险因素(P<0.05)。构建模型组的曲线下面积为0.800，灵敏度为0.697，特异度为0.791,Hosmer-Lemeshow拟合优度检验结果显示χ2=7.486,P=0.485，预测模型的拟合情况良好，一致性较好，临床适用价值较高。结论 肝细胞癌患者肝切除术中大出血发生率有待降低。基于5项独立危险因素构建的预测模型临床实用价值较强，可辅助医护人员术前识别高风险患者并制订针对性干预措施。
Abstract：Objective To explore the risk factors of massive bleeding during hepatectomy in patients with hepatocellular carcinoma,and to construct and verify a risk early warning model based on this.Methods A total of 186 patients with hepatocellular carcinoma who underwent hepatectomy in a hospital from March 2021 to October 2023 were selected as the model group.They were divided into the bleeding group(n=33) and the non-bleeding group(n=153) according to whether massive hemorrhage occurred during the operation.Univariate and multivariate Logistic regression analyses were used to identify influencing factors and construct a predictive model.Another 79 hepatocellular carcinoma patients undergoing liver resection were included as the validation group.Results The incidence of massive hemorrhage during hepatectomy in patients with hepatocellular carcinoma in the model group was 17.74%(33/186).The results of multivariate analysis showed that tumor diameter>5.0 cm,preoperative PLT<100×109/L,operation time≥5 hours,tumor location in the inferior vena cava of the right posterior lobe of the liver,and a large extent of liver resection were all independent risk factors for massive hemorrhage during liver resection in patients with hepatocellular carcinoma(P<0.05).The area under the ROC curve of the model construction group was 0.800,the sensitivity was 0.697,and the specificity was 0.791.The goodness-fit test results of H-L showed that χ2=7.486,P=0.485.The fitting of the predictive model was good,the consistency was good,and the clinical application value was high.Conclusion The incidence of massive bleeding during liver resection in hepatocellular carcinoma patients warrants attention.The predictive model constructed based on five independent risk factors has strong clinical practical value and can assist healthcare professionals in identifying high-risk patients preoperatively and formulating targeted intervention measures.
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基本信息:
中图分类号:R473.73
引用信息:
[1]钟雅俊,车汉洋,吴曼倩,等.肝细胞癌患者肝切除术中大出血风险预警模型构建与验证[J].护理管理杂志,2025,25(11):940-944.
基金信息:
丽水市科技计划项目（2023SJZC001）