广西医学

目的探讨髋部骨折患者术后延迟拔除尿管的危险因素并建立列线图预测模型。方法回顾性分析125例髋部骨折术后留置尿管的患者的临床资料，将患者分为建模组（n=87）和验证组（n=38）。采用多因素Logistic回归模型分析建模组髋部骨折患者术后延迟拔除尿管的影响因素。通过R语言软件构建列线图预测模型，采用Bootstrap法对模型进行内部验证；利用验证组的数据对模型进行外部验证，分别采用受试者工作特征曲线、校准曲线及决策曲线分析（DCA）评估模型的区分度、校准度及临床适用性。结果合并基础疾病数量、术前自理能力及术前低蛋白血症是髋部骨折术后患者延迟拔除尿管的影响因素（P<0.05）。采用列线图预测模型预测髋部骨折患者术后延迟拔除尿管时，建模组与验证组的曲线下面积分别为0.753和0.874；校准曲线提示建模组和验证组的预测概率与实际概率基本相符；当建模组和验证组的阈值概率分别在30%~100%和20%~100%时，髋部骨折术后尽早拔除尿管可能会使患者获益更多。结论合并基础疾病数量、术前自理能力及术前低蛋白血症是髋部骨折术后患者延迟拔除尿管的影响因素。基于上述影响因素构建的预测模型具有良好的区分度、准确度及临床适用性，有助于护理人员早识别、早干预延迟拔除尿管高风险人群。

Objective To investigate the risk factors of urinary catheter delayed extubation in patients after hip fracture surgery, and to establish a nomogram prediction model. Methods The clinical data of 125 patients with indwelling urinary catheter after hip fracture surgery were retrospectively analyzed. Patients were assigned to modeling group (n=87) or validation group (n=38). The multivariate Logistic regression model was used to analyze the influencing factors for delayed extubation of urinary catheter in patients after hip fracture surgery. A nomogram prediction model was established through the R language software. Internal validation was performed on the model by using the Bootstrap method, and external validation was performed on the model by employing the data of the validation group. Discrimination degree, calibration degree and clinical applicability were evaluated by using the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). Results Number of concomitant basic diseases, preoperative self-care ability, and preoperative hypoproteinemia were the influencing factors for delayed extubation of urinary catheter in patients after hip fracture surgery (P<0.05). When employing the nomogram prediction model for predicting delayed extubation of urinary catheter in patients after hip fracture surgery, areas under the curve of the modeling group and the validation group were 0.753 and 0.874, respectively, and calibration curve indicated that predictive probabilities of the modeling group and the validation group were basically consistent with actual probabilities. When the threshold probabilities were 30%-100% and 20%-100% in the modeling group and the validation group, extubation of urinary catheter after hip fracture surgery as soon as possible might benefit patients more. Conclusion Number of concomitant basic diseases, preoperative self-care ability, and preoperative hypoproteinemia are the influencing factors for delayed extubation of urinary catheter in patients after hip fracture surgery. The prediction model established based on the aforementioned influencing factors exerts favorable discrimination degree, accuracy, and clinical applicability, which is helpful for nursing personnel to early recognize, and early intervene high-risk population of delayed extubation of urinary catheter.