基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素。

回顾性分析2018年10月至2020年10月105例行全身麻醉腹腔镜胆囊切除术的患者资料，按照术后是否发生肠道功能紊乱，分为紊乱组（n=26）和正常组（n=79）。用SPSS 22.0软件进行统计分析，采用多因素Logistic回归分析患者术后肠道功能紊乱的影响因素，采用R（R3.5.3）软件包和rms程序包制作列线图模型并验证；依据列线图模型预测个体得分采用递归分割分析（RPA）法建立危险分层系统，并进行亚组分析，采用Kaplan-Meier绘制生存曲线，并采用Log-Rank检验对生存曲线进行比较。P<0.05为差异有统计学意义。

紊乱组患者术后肠鸣音恢复时间、首次排气时间、首次排便时间、腹胀评分、腹痛评分均高于正常组（P<0.05），二胺氧化酶、D-乳酸、肿瘤坏死因子a（TNF-a）、白细胞介素-6（IL-6）、葡萄球菌水平高于正常组，乳酸杆菌水平低于正常组（P<0.05）。多因素Logistic回归分析显示，二胺氧化酶、D-乳酸、TNF-a、IL-6以及葡萄球菌是全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的独立影响因素，乳酸杆菌为保护因素（P<0.05）。依据独立影响因素构建的列线图模型内部验证前后AUC分别为0.849（95%CI:0.738~0.892）和0.827（95%CI:0.721~0.863），灵敏度分别为88.2%和87.9%，特异度分别为92.5%和91.4%，模型预测的区分度和有效性均较好。决策曲线显示阈值概率在1.0%~90.0%时，有较高的净获益值。危险分层系统将所有患者分为4个危险分组，该危险分层系统可对患者生存进行区分（P<0.05）。

行全身麻醉腹腔镜胆囊切除术后，患者如有二胺氧化酶、D-乳酸、TNF-a、IL-6、乳酸杆菌、葡萄球菌等指标水平异常的情况，需注意肠道功能紊乱的情况发生。

To explore the influencing factors of postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia based on the nomogram model.

Data of 105 patients undergoing laparoscopic cholecystectomy under general anesthesia from October 2018 to October 2020 were retrospectively analyzed. According to whether postoperative intestinal dysfunction occurred, the patients were divided into disordered group (n=26) and normal group (n=79). SPSS 22.0 software was used for statistical analysis, multi-factor Logistic regression was used to analyze the influencing factors of postoperative intestinal dysfunction in patients, and R (R3.5.3) software package and rms package were used to make a nomogram model and verify it. The risk stratification system was established by recursive segmentation analysis (RPA), and subgroup analysis was performed. Survival curves were drawn by Kaplan-Meier and compared by Log-Rank test. P<0.05 was considered statistically significant.

The intestinal sound recovery time, first venting time, first defecation time, abdominal distension score and abdominal pain score of patients with disorder group were higher than those of normal group (P< 0.05), and the levels of diamine oxidase, D-lactic acid, tumor necrosis factor a (TNF-a), interleukin-6 (IL-6) and staphylococcus were higher than those of normal group. The level of lactobacillus was lower than that of normal group (P< 0.05). Multivariate Logistic regression analysis showed that diamine oxidase, D-lactic acid, TNF-a, IL-6 and staphylococcus were independent influencing factors for postoperative intestinal dysfunction in patients undergoing laparoscopic cholecystectomy under general anesthesia, and lactobacillus was the protective factor (P< 0.05). The value of the nomogram model constructed according to independent influencing factors was AUC before and after internal validation were 0.849 (95%CI:0.738~0.892) and 0.827 (95%CI:0.721~0.863), sensitivity was 88.2% and 87.9%, specificity was 92.5% and 91.4%, respectively. and the differentiation and validity of the model prediction were good. The decision curve shows that when the threshold probability is between 1.0% and 90.0%, there is a higher net benefit value. The risk stratification system divided all patients into four risk groups, and the risk stratification system could distinguish patient survival (P<0.05).

After laparoscopic cholecystectomy under general anesthesia, patients with abnormal levels of diamine oxidase, D-lactic acid, TNF-a, IL-6, lactobacillus, staphylococcus and other indicators should pay attention to the occurrence of intestinal function disorders.