Abstract:

Objective To construct a risk prediction model for intraoperative acquired pressure injury（IAPI） during neurosurgery in pediatric patients，and verify the predictive effect of the model，to provide a reference for preventing IAPI during neurosurgery in pediatric patients. Methods The clinical data of 776 pediatric patients undergoing neurosurgery in a tertiary-level hospital in Chongqing from January to June 2023 were retrospectively collected. The risk factors for IAPI were explored through univariate analysis and binary Logistic regression analysis. The fitting degree and predictive effect of the model were verified by Hosmer-Lemeshow test and receiver operator characteristic（ROC） curve，respectively. The model was validated internally by Bootstrap. Results The incidence of IAPI during neurosurgery in pediatric patients was 7.99%. Logistic regression analysis showed that bleeding volume，anesthesia time，age，intraoperative use of instruments such as drills and milling cutters that increase external force，and surgical position were the factors influencing IAPI in neurosurgical children（all P<0.05）. The results of the Hosmer-Lemeshow test showed that χ²=3.636，P=0.888. The results of internal verification showed that the sensitivity of the model was 0.59；the specificity was 0.81；the area under the ROC curve was 0.79. Conclusion This study analyzes the risk factors for IAPI during neurosurgery in pediatric patients and constructs a line chart prediction model with good predictive performance，which can provide a reference for individualized prediction of the risk of IAPI during neurosurgery in pediatric patients. It can provide a scientific basis for clinical nursing staff to identify high-risk children with IAPI early and take personalized preventive measures in time.

Key words: Neurosurgery, Intraoperative Acquired Pressure Injury, Nomograph, Pediatric Nursing

摘要：

目的 构建神经外科患儿术中获得性压力性损伤（intraoperative acquired pressure injury，IAPI）风险预测模型，并验证模型的预测效果，旨在为神经外科患儿IAPI的防范提供参考。 方法 回顾性收集2023年1月—6月在重庆市某三级甲等儿童专科医院接受神经外科手术的776例患儿的临床资料。通过单因素分析和二元Logistic回归分析探讨IAPI的风险因素，绘制神经外科患儿IAPI列线图预测模型，采用Hosmer-Lemeshow检验和受试者操作特征（receiver operator characteristic，ROC）曲线下面积检验模型的拟合优度及预测效果，采用Bootstrap法进行内部验证。结果 神经外科患儿IAPI的发生率为7.99%。Logistic回归分析结果显示，术中出血量、麻醉时间、年龄、术中是否使用钻头及铣刀等增加外力的仪器、手术体位是神经外科患儿IAPI的影响因素（均P<0.05）；Hosmer-Lemeshow检验结果显示，χ²=3.636，P=0.888。内部验证结果显示，模型的灵敏度为0.59，特异度为0.81，ROC曲线下面积为0.79。结论 该研究构建的神经外科患儿IAPI列线图预测模型有一定预测效能，可为临床护理人员早期识别IAPI高风险患儿、及时采取个性化预防措施提供科学依据。

关键词: 神经外科, 术中获得性压力性损伤, 列线图, 儿科护理学