Department of General Surgery, Zhejiang Hospital, Zhejiang Province-China.
Department of General Surgery, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Zhejiang Province-China.
Ulus Travma Acil Cerrahi Derg. 2023 Feb;29(2):169-175. doi: 10.14744/tjtes.2022.67669.
The incidence of blunt abdominal injury has significantly increased, and the liver is one of the most commonly damaged organs. In this study, we explored and established a nomogram model for patients with liver ruptures undergoing surgical treatment.
A retrospective analysis was conducted for 66 adult patients with liver rupture, who were admitted to our hospital from January 2011 to October 2018. These patients were classified into two groups, according to whether the patient had surgery: surgery group (41 cases) and non-surgical group (25 cases). The following data were collected from these two groups of patients: gender, age, injury mechanism, liver damage, laboratory test results, and hospitalization. Multivariate logistic regression analysis was performed to screen the risk factors of patients who require surgical treatment, establish a predictive model based on the selected indicators, and draw the nomogram. Receiver operating characteristic curves and the calibration curve were used to evaluate the predictive value of the model.
Compared to the non-surgical group, the body temperature decreased, the heart rate increased, the injury severity score grade increased, the blood urea nitrogen, blood uric acid, creatinine (Cr), arterial partial pressure of oxygen, alkali excess, blood lactic acid and creatine kinase isoenzymes MB (CK-MB) increased, and the HCO- and Glasgow Coma Scale (GCS) coma scores decreased for patients in the surgical group (all, p<0.05). The logistic regression analysis revealed that Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, and the Glasgow coma score were the influencing factors for surgical intervention for liver rupture. The nomo-gram model constructed based on these five indicators had a good degree of discrimination (area under the curve = 0.971, 95% CI: 0.896-0.997) and accuracy.
A nomogram model established based on Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, the GCS, and other parameters can accurately predict the surgical treatment of patients with liver rupture.
钝性腹部损伤的发病率显著增加，肝脏是最常受损的器官之一。本研究旨在探讨和建立接受手术治疗的肝破裂患者的列线图模型。
回顾性分析 2011 年 1 月至 2018 年 10 月我院收治的 66 例成人肝破裂患者，根据患者是否接受手术分为手术组（41 例）和非手术组（25 例）。收集两组患者的性别、年龄、损伤机制、肝损伤、实验室检查结果和住院时间等资料。对需要手术治疗的患者进行多因素 logistic 回归分析，筛选出有意义的指标，建立预测模型，并绘制列线图。采用受试者工作特征曲线和校准曲线评价模型的预测价值。
与非手术组相比，手术组患者的体温降低，心率升高，损伤严重程度评分升高，血尿素氮、血尿酸、肌酐（Cr）、动脉血氧分压、碱剩余、血乳酸和肌酸激酶同工酶 MB（CK-MB）升高，HCO3-和格拉斯哥昏迷评分（GCS）降低（均 P<0.05）。logistic 回归分析显示，Cr、动脉血氧分压、HCO3-、CK-MB 和 GCS 是影响肝破裂手术干预的因素。基于这 5 个指标构建的列线图模型具有较好的区分度（曲线下面积=0.971，95%CI：0.896-0.997）和准确性。
基于 Cr、动脉血氧分压、HCO3-、CK-MB、GCS 等参数建立的列线图模型可准确预测肝破裂患者的手术治疗。
