【摘要】 目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿术后阻塞性睡眠呼吸暂停(OSA)残余的影响因素，并构建列线图风险模型。方法 回顾性分析行腺样体/扁桃体切除术的283例OSAHS患儿的临床资料。将患儿随机分为建模队列(n=198)和验证队列(n=85),并根据术后12个月是否存在OSA残余，将建模队列患儿分为治愈组(n=145)和术后OSA残余组(n=53)。采用多因素Logistic回归模型分析OSAHS患儿术后OSA残余的危险因素。基于危险因素构建列线图风险模型，用Bootstrap法进行内部验证，利用验证队列进行外部验证。结果 283例OSAHS患儿中，有75例(26.5%)患儿发生术后OSA残余。多因素Logistic回归分析结果显示，体质指数>24 kg/m~2、术前呼吸暂停低通气指数>18次/h、术前自发觉醒次数>8次/h、合并哮喘均是OSAHS患儿术后OSA残余的独立影响因素(均P<0.05)。基于上述危险因素构建的列线图风险模型的校准度、区分度均良好，具有良好的预测能力。决策曲线分析结果显示，当预测的风险≥6%时，使用该模型评估OSAHS患儿术后OSA残余发生风险会获得更多的收益。结论 体质指数>24 kg/m~2、术前呼吸暂停低通气指数>18次/h、术前自发觉醒次数>8次/h、合并哮喘是OSAHS患儿术后OSA残余的独立危险因素。基于上述因素构建的列线图风险模型有助于临床医生早期识别术后OSA残余的高风险患儿。更多还原

【Abstract】 Objective To investigate the influencing factors for postoperative obstructive sleep apnea(OSA) residue in children with obstructive sleep apnea-hypopnea syndrome(OSAHS), and to establish the nomogram risk model. Methods The clinical data of 283 OSAHS children undergoing adenoidectomy/tonsillectomy were retrospectively analyzed, and they were randomly assigned to derivation cohort(n=198) or validation cohort(n=85), and children in the derivation cohort were assigned to cure group(n=145) or postoperative OSA residue group(n=53) according to the presence of OSA residue 12 months after operation. The risk factors for postoperative OSA residue in OSAHS children were analyzed by using the multivariate Logistic regression model. The nomogram risk model was established based on the risk factors, and the Bootstrap method was employed to perform internal validation, and external validation was performed by using the validation cohort. Results Among the 283 OSAHS children, 75(26.5%) children suffered from postoperative OSA residue. The results of multivariate Logistic regression analysis revealed that the body mass index>24 kg/m~2, preoperative apnea-hypopnea index>18 times per hour, preoperative spontaneous awakening frequency>8 times per hour, and concomitant asthma were the independent influencing factors for postoperative OSA residue in OSAHS children(all P<0.05). The calibration and discrimination of the nomogram risk model established based on aforesaid risk factors were favorable, exerting a favorable prediction capacity. The results of decision curve analysis implied that when the prediction risk≥6%, more benefits would be acquired by using this model to evaluate the occurrence risk of postoperative OSA residue in OSAHS children. Conclusion The body mass index>24 kg/m~2, preoperative apnea-hypopnea index>18 times per hour, preoperative spontaneous awakening frequency>8 times per hour, and concomitant asthma are the independent risk factors for postoperative OSA residue in OSAHS children. The nomogram risk model established based on aforementioned factors can facilitate clinicians to early identify postoperative OSA residue in children with high risk.更多还原