老年结肠镜检查患者肠道准备失败风险评分模型的构建及验证

doi:10.3761/j.issn.0254-1769.2022.11.009

摘要/Abstract

摘要：

目的分析老年结肠镜检查患者肠道准备失败的危险因素,并构建风险评分模型,为制订针对性的干预措施提供依据。方法采用便利抽样法,选取2021年5月—10月在太原市某三级甲等医院进行结肠镜检查的610例老年患者作为调查对象,采用随机数字表法分为建模组（406例）和验证组（204例）。依据肠道准备质量,将建模组患者分为肠道准备成功组和失败组,采用Logistic回归分析确定肠道准备失败的独立危险因素,并构建风险评分模型。采用Hosmer-Lemeshow χ²检验及受试者操作特征曲线下面积评价模型的预测效果。结果 Logistic回归分析结果显示,年龄>65岁、BMI≥24、合并便秘、合并糖尿病、有结直肠手术史、首次进行结肠镜检查是老年患者肠道准备失败的独立危险因素,相应的风险评分依次为2、2、3、2、5、4分,评分≥8分为高风险人群。建模组检验结果显示,Hosmer-Lemeshow χ²=8.969,P=0.255;受试者操作特征曲线下面积为0.717（P<0.001）,灵敏度为50.89%,特异度为79.59%。验证组检验结果显示,Hosmer-Lemeshow χ²=4.188,P=0.840;受试者操作特征曲线下面积为0.720（P<0.001）,灵敏度为48.38%,特异度为81.69%,正确率为71.57%。结论该研究构建的风险评分模型的预测效果良好,可为临床医护人员评估老年结肠镜检查患者肠道准备失败的风险提供参考。

关键词: 老年人, 结肠镜检查, 肠道准备, 危险因素, 模型,统计学, 护理

Abstract:

Objective To analyze the influencing factors of inadequate bowel preparation in elderly patients undergoing colonoscopy,to construct a risk score model,and to provide the evidence for targeted intervention measures. Methods A total of 610 elderly patients undergoing colonoscopy in a tertiary A hospital in Taiyuan from May 2021 to October 2021 were enrolled by convenience sampling method,and they were divided into a development group （406 cases） and a validation group （204 cases） by random number table method. The patients in the development group were divided into a successful group and a failed group according to the quality of bowel preparation. Then the Logistic regression analysis was used to analyze the risk factors and construct risk score model. Hosmer-Lemeshow χ² test and the area under the ROC curve were used to evaluate the predictive effect of the model. Results Logistic regression analysis showed that age>65 years,BMI≥24,constipation,diabetes,history of colorectal surgery,and the first experience of colonoscopy were independent risk factors for inadequate bowel preparation in elderly patients,and the corresponding risk score were 2,2,3,2,5,4 points,respectively （high-risk group included patients scored≥8 points）. In the development group,the results showed that Hosmer-Lemeshow χ²=8.969,P=0.255;the area under ROC curve was 0.717（P<0.001）,with the sensitivity and specificity of 50.89% and 79.59%. In the validation group,the results showed that Hosmer-Lemeshow χ²=4.188,P=0.840;the area under the ROC curve was 0.720（P<0.001）,with the sensitivity and the specificity of 48.38% and 81.69%,and the accuracy was 71.57%. Conclusion The risk score model constructed in this study has good predictive effects and it can provide the reference for clinical assessment of inadequate bowel preparation risk in elderly patients undergoing colonoscopy.

Key words: Aged, Colonoscopy, Bowel Preparation, Risk Factors, Models,Statistical, Nursing Care

徐苗苗, 付秀荣, 张娜, 王越, 史方竹. 老年结肠镜检查患者肠道准备失败风险评分模型的构建及验证[J]. 中华护理杂志, 2022, 57(11): 1337-1344.

XU Miaomiao, FU Xiurong, ZHANG Na, WANG Yue, SHI Fangzhu. Development and validation of a risk score model for inadequate bowel preparation for colonoscopy in elderly patients[J]. Chinese Journal of Nursing, 2022, 57(11): 1337-1344.

图/表 5

表1 老年结肠镜检查患者肠道准备失败的单因素分析[例（百分比,%）]

Table 1 Univariate analysis of the factors of inadequate bowel preparation for colonoscopy in elderly patients [cases（percentage,%）]

表2 自变量赋值表

Table 2 Assignment of predictors

表3 老年结肠镜检查患者肠道准备失败的多因素分析及风险评分

Table 3 Logistic regression analysis and risk score of the factors of inadequate bowel preparation for colonoscopy in elderly patients

图1 建模组肠道准备失败风险评分模型的受试者操作特征曲线

Figure 1 Receiver operating characteristic curve of the risk score model for inadequate bowel preparation in the development group

图2 验证组肠道准备失败风险评分模型的受试者操作特征曲线

Figure 2 Receiver operating characteristic curve of the risk score model for inadequate bowel preparation in the validation group

参考文献 32

[1]	Hassan C, East J, Radaelli F, et al. Bowel preparation for colo-noscopy:European Society of Gastrointestinal Endoscopy(ESGE) guideline-update 2019[J]. Endoscopy, 2019, 51(8):775-794. DOI URL
[2]	Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy:systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate[J]. Am J Gastroenterol, 2014, 109(11):1714-1723. DOI URL
[3]	张媛媛, 钮美娥, 汪茜雅, 等. 肠道准备关键点指导方案在老年患者结肠镜检查中的应用研究[J]. 中国内镜杂志, 2018, 24(11):22-27.
	Zhang YY, Niu ME, Wang XY, et al. Application of the key-point guidelines of bowel preparation for elderly patients with colonoscopy[J]. China J Endosc, 2018, 24(11):22-27.
[4]	Kim HG. Is elderly age a simple predictive factor for inadequate bowel preparation before colonoscopy?[J]. Gut Liver, 2016, 10(4):489-490. DOI URL
[5]	Ho SB, Hovsepians R, Gupta S. Optimal bowel cleansing for colonoscopy in the elderly patient[J]. Drugs Aging, 2017, 34(3):163-172. DOI URL
[6]	Zhang YY, Niu ME, Wu ZY, et al. The incidence of and risk factors for inadequate bowel preparation in elderly patients:a prospective observational study[J]. Saudi J Gastroenterol, 2018, 24(2):87-92. DOI URL
[7]	Anderson JC, Baron JA, Ahnen DJ, et al. Factors associated with shorter colonoscopy surveillance intervals for patients with low-risk colorectal adenomas and effects on outcome[J]. Gastroenterology, 2017, 152(8):1933-1943. DOI PMID
[8]	Sulz MC, Kröger A, Prakash M, et al. Meta-analysis of the effect of bowel preparation on adenoma detection:early adenomas affected stronger than advanced adenomas[J]. PLoS One, 2016, 11(6):e0154149. DOI URL
[9]	梁蓉, 杨支兰, 闫晓晓, 等. 老年患者结肠镜检查前肠道准备现状及其影响因素分析[J]. 中国护理管理, 2019, 19(2):182-187.
	Liang R, Yang ZL, Yan XX, et al. Analysis of the status and influencing factors of intestinal preparation before colonoscopy in elderly patients[J]. Chin Nurs Manag, 2019, 19(2):182-187.
[10]	Kumar A, Lin LS, Bernheim O, et al. Effect of functional status on the quality of bowel preparation in elderly patients undergoing screening and surveillance colonoscopy[J]. Gut Liver, 2016, 10(4):569-573. DOI URL
[11]	Chen Y, Du H, Wei BH, et al. Development and validation of risk-stratification delirium prediction model for critically ill patients:a prospective,observational,single-center study[J]. Medi-cine(Baltimore), 2017, 96(29):e7543.
[12]	王俊峰, 章仲恒, 周支瑞, 等. 临床预测模型:模型的验证[J]. 中国循证心血管医学杂志, 2019, 11(2):141-144.
	Wang JF, Zhang ZH, Zhou ZR, et al. Clinical prediction models:model validation[J]. Chin J Evid Based Cardiovasc Med, 2019, 11(2):141-144.
[13]	中华医学会消化内镜学分会. 中国消化内镜诊疗相关肠道准备指南(2019 上海)[J]. 中华内科杂志, 2019, 58(7):485-495.
	Chinese Society of Digestive Endoscopy, Chinese Medical Association. Chinese guideline for bowel preparation for colonoscopy (2019,Shanghai)[J]. Chin J Intern Med, 2019, 58(7):485-495.
[14]	张媛媛, 钮美娥, 汪茜雅, 等. 结肠镜检查前肠道准备效果的现况调查及影响因素分析[J]. 中国实用护理杂志, 2017, 33(14):1085-1088.
	Zhang YY, Niu ME, Wang XY, et al. Investigation on the effect of bowel preparation before colonoscopy and its influencing factors[J]. Chin J Pract Nurs, 2017, 33(14):1085-1088.
[15]	徐梦辉, 赵滨, 马俊骥, 等. 门诊结肠镜检查患者的肠道准备现状及其影响因素研究[J]. 中华护理杂志, 2017, 52(12):1473-1477.
	Xu MH, Zhao B, Ma JJ, et al. The status and influencing factors of bowel preparation for outpatient colonoscopy[J]. Chin J Nurs, 2017, 52(12):1473-1477.
[16]	Lai EJ, Calderwood AH, Doros G, et al. The Boston Bowel Preparation Scale:a valid and reliable instrument for colonoscopy-oriented research[J]. Gastrointest Endosc, 2009, 69(3 Pt 2):620-625. DOI URL
[17]	高燕, 张厚德, 林木贤, 等. Boston肠道准备量表应用的信度评估[J]. 中华消化内镜杂志, 2012, 29(2):78-80.
	Gao Y, Zhang HD, Lin MX, et al. Reliability of the Boston Bowel Preparation Scale[J]. Chin J Dig Endosc, 2012, 29(2):78-80.
[18]	Calderwood AH, Schroy PC, Lieberman DA, et al. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness[J]. Gastrointest Endosc, 2014, 80(2):269-276. DOI PMID
[19]	Abizanda P, Romero L, Sánchez-Jurado PM, et al. Association between functional assessment instruments and frailty in older adults:the FRADEA study[J]. J Frailty Aging, 2012, 1(4):162-168. DOI PMID
[20]	方秀才. 罗马Ⅳ诊断标准在慢性便秘诊断中的应用[J]. 中华胃肠外科杂志, 2016, 19(12):1321-1323.
	Fang XC. Application of Roman Ⅳ criteria in the diagnosis of chronic constipation[J]. Chin J Gastrointest Surg, 2016, 19(12):1321-1323.
[21]	赵斌亮. 下肢深静脉血栓患者并发肺栓塞预测模型的建立及验证[D]. 太原: 山西医科大学, 2018.
	Zhao BL. Development and validation of predictive model for pulmonary embolism in patients with deep venous thrombosis of lower extremities[D]. Taiyuan: Shanxi Medical University, 2018
[22]	梁国栋, 刘广遐, 张婷婷, 等. 老年人肠道准备质量的相关影响因素分析[J]. 实用老年医学, 2017, 31(12):1148-1150.
	Liang GD, Liu GX, Zhang TT, et al. Analysis of the influencing factors of quality of bowel preparation in the elderly[J]. Pract Geriatr, 2017, 31(12):1148-1150.
[23]	Borg BB, Gupta NK, Zuckerman GR, et al. Impact of obesity on bowel preparation for colonoscopy[J]. Clin Gastroenterol Hepatol, 2009, 7(6):670-675. DOI URL
[24]	卫生部疾病控制司. 中国成人超重和肥胖症预防控制指南[M]. 北京: 人民卫生出版社, 2006.
	Department of Disease Control, Ministry of Health,PRC. Guidelines for prevention and control of adult overweight and obesity in China[M]. Beijing: People’s Medical Publishing House, 2006.
[25]	Cheng CL, Liu NJ, Tang JH, et al. Predictors of suboptimal bowel preparation using 3-l of polyethylene glycol for an outpatient colonoscopy:a prospective observational study[J]. Dig Dis Sci, 2017, 62(2):345-351. DOI URL
[26]	吴丹. 老年人不充分肠道准备预测因素的研究[D]. 青岛: 青岛大学, 2018.
	Wu D. Predictors of inadequate bowel preparation in the elderly[D]. Qingdao: Qingdao University, 2018.
[27]	张瑜, 李利. 糖尿病患者血糖控制程度对肠镜检查肠道清洁度的影响[J]. 中华护理杂志, 2010, 45(12):1107-1108.
	Zhang Y, Li L. The influence of blood glucose control on the bowel cleanliness in diabetic patients before colonoscopy[J]. Chin J Nurs, 2010, 45(12):1107-1108.
[28]	曹春玲, 江颖, 闫雅凤. 老年糖尿病患者病程和血糖控制水平与肠道清洁度的相关性[J]. 军医进修学院学报, 2012, 33(5):487-488.
	Cao CL, Jiang Y, Yan YF. Correlation between duration of diabetes mellitus,controlled blood glucose level and intestinal cleaning degree in elderly diabetic patients[J]. J Chin PLA Postgrad Med Sch, 2012, 33(5):487-488.
[29]	Moris D, Chakedis J, Rahnemai-Azar AA, et al. Postoperative abdominal adhesions:clinical significance and advances in prevention and management[J]. J Gastrointest Surg, 2017, 21(10):1713-1722. DOI URL
[30]	廖少玲, 文若兰, 赖敏贞. 心理社会因素对功能性消化不良患者的影响[J]. 中华护理杂志, 2004, 39(4):307-308.
	Liao SL, Wen RL, Lai MZ. Effect of psychosocial factors on functional dyspepsia[J]. Chin J Nurs, 2004, 39(4):307-308.
[31]	娄青玲, 高峰, 张枚. 复方聚乙二醇电解质散肠道准备的多因素Logistic回归分析[J]. 中华临床医师杂志(电子版), 2017, 11(9):1505-1508.
	Lou QL, Gao F, Zhang M. Multiple Logistic regression analysis about bowel preparation quality using polyethylene glycol electrolytes powder[J]. Chin J Clin Electron Ed, 2017, 11(9):1505-1508.
[32]	邢焕民, 吕冬梅, 王晓慧, 等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志, 2019, 54(1):8-13.
	Xing HM, Lü DM, Wang XH, et al. The development and application of a risk prediction model for postoperative delirium in ICU patients[J]. Chin J Nurs, 2019, 54(1):8-13.