国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (5): 634-643.doi: 10.7518/gjkq.2025095

• 论著 • 上一篇    下一篇

口腔癌游离皮瓣重建患者气管切开术后肺炎风险预测模型的构建

陈玉1,2(),雷银富3,吴和梅1,杜福兰4,党洁4,陈永梅1,陶明1(),石兴莲5   

  1. 1.遵义医科大学附属医院护理部 遵义 563000
    2.西南医科大学附属医院口腔外科 泸州 646000
    3.西南医科大学附属医院手术室 泸州 646000
    4.川北医学院附属医院口腔外科 南充 637000
    5.遵义医科大学附属口腔医院护理部 遵义 563000
  • 收稿日期:2024-03-22 修回日期:2025-04-30 出版日期:2025-09-01 发布日期:2025-08-27
  • 通讯作者: 陶明
  • 作者简介:陈玉，主管护师，硕士，Email：814807787@qq.com
  • 基金资助:
    贵州省科技计划项目（黔科合成果-LC［2022］006）

Development of a risk prediction model for pneumonia after tracheotomy in patients with oral cancer undergoing free flap reconstruction

Yu Chen1,2(),Yinfu Lei3,Hemei Wu1,Fulan Du4,Jie Dang4,Yongmei Chen1,Ming Tao1(),Xinglian Shi5   

  1. 1.Dept. of Nursing, Zunyi Medical University Affiliated Hospital, Zunyi 563000, China
    2.Dept. of Oral and Maxillofacial Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
    3.Operating Room, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
    4.Dept. of Oral and Maxillofacial Surgery, Affiliated to North Sichuan Medical College, Nanchong 637000, China
    5.Dept. of Nursing, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi 563000, China
  • Received:2024-03-22 Revised:2025-04-30 Online:2025-09-01 Published:2025-08-27
  • Contact: Ming Tao
  • Supported by:
    Guizhou Provincial Science and Technology Plan Project (Qianke Synthetic Fruit LC[2022]006)

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摘要：

目的 探讨口腔癌游离皮瓣重建患者气管切开术后肺炎（POP）的危险因素，并基于Logistic回归模型和决策树模型构建口腔癌游离皮瓣重建患者POP的风险预测模型。 方法 回顾性收集2017年1月—2023年9月在中国西南地区3家医院行气管切开的299例口腔癌游离皮瓣重建患者的临床资料。采用多因素Logistic回归分析口腔癌游离皮瓣重建患者气管切开后POP的危险因素，运用SPSS Modeler18.0软件构建口腔癌游离皮瓣重建患者气管切开后POP的决策树模型，并评价2种模型的预测效能。 结果 共纳入299例患者，POP患者56例，POP发病率为18.73%。Logistic回归分析显示，气管套管留置时间［OR=1.097，95%CI（1.039，1.158）］、颌骨切除［OR=2.439，95%CI（1.084，5.484）］、吻合静脉数量［OR=3.345，95%CI（1.449，7.719）］和术后抗生素种类≥3［OR=14.732，95%CI（4.405，49.273）］是口腔癌游离皮瓣重建患者气管切开后发生POP的独立危险因素（P<0.05）。决策树模型显示，术后住院时间（>14 d）是口腔癌POP发生的主要危险因素，其次是吻合静脉数量、术后抗生素种类等。受试者工作特征曲线下面积显示，决策树模型的预测能力稍优于Logistic回归模型。 结论 口腔癌游离皮瓣患者POP的危险因素较多，决策树模型在本研究中对POP的预测效能稍好，临床可应用该模型了解口腔癌游离皮瓣重建患者气管切开后易发生POP的相关特征，并验证其预测效能。

关键词: 口腔癌, 皮瓣重建, 气管切开术, 术后肺炎, Logistic回归模型, 决策树模型

Abstract:

Objective This study aims to explore the risk factors for postoperative pneumonia (POP) in patients with oral cancer undergoing free flap reconstruction after tracheostomy and develop a risk prediction model for POP in patients with oral cancer undergoing free flap reconstruction on the basis of a logistic regression model and a decision tree model. Methods Retrospective collection of clinical data was performed on 299 patients with oral cancer who underwent tracheostomy with free flap reconstruction in three hospitals in southwestern China from January 2017 to September 2023. Logistic regression analysis was conducted to identify the risk factors for POP in patients with oral cancer free flap reconstruction. SPSS Modeler 18.0 software was used to develop a decision tree model for POP in patients with oral cancer free flap reconstruction, and the predictive performance of the two models was evaluated. Results A total of 299 patients, including 56 POP patients (POP incidence rate of 18.73%), were included in this study. Logistic regression analysis revealed that the time of tracheal cannula retention (OR=1.097, 95%CI[1.039, 1.158]), jawbone resection (OR=2.439, 95%CI[1.084, 5.484]), number of anastomotic veins (OR=3.345, 95%CI[1.449, 7.719]), and postoperative antibiotic types≥3 (OR=14.732, 95%CI[4.405, 49.273]) were independent risk factors for POP after tracheostomy in patients with oral cancer free flap reconstruction (P<0.05). The decision tree model showed that postoperative hospitalization time (>14 days) was the main risk factor for the occurrence of POP in oral cancer, followed by the number of anastomotic veins and the type of postoperative antibiotics. The receiver operating characteristic curve revealed that the decision tree model had slightly better predictive ability than the logistic regression model. Conclusion Patients with oral cancer undergoing free flap reconstruction face many risk factors for POP. The decision tree model demonstrated a slightly better predictive performance for POP in this study. It can be used to understand the relevant characteristics of POP after tracheostomy in patients with free flap reconstruction of oral cancer, and its prediction performance should be verified.

Key words: oral cancer, flap reconstruction, tracheostomy, postoperative pneumonia, Logistic regression model, decision tree model

中图分类号: 

  • R473.78

表 1

2组患者术前特征及POP单因素分析"

变量POP组非POP组χ2/Z值P值
性别/例（%）2.0760.150
男48（85.7）187（77.0）
女8（14.3）56（23.0）
年龄*/岁56（53，66.5）57（49，65）-1.1030.270
BMI*/（kg/m2）22.65（21.46，24.15）23.13（20.96，25.65）-1.1230.261
吸烟史/例（%）32（57.1）139（57.2）0.0000.994
饮酒史/例（%）29（51.8）105（43.2）1.3530.245
糖尿病史/例（%）2（3.6）27（11.1）2.9540.086
高血压史/例（%）18（32.1）73（30.0）0.0950.758
术前放化疗史/例（%）1（1.8）11（4.5）0.8880.704
肺部共病/例（%）14（25.0）38（15.6）2.7770.096
脑血管疾病史/例（%）10（17.9）19（7.8）5.2360.022
周围血管疾病史/例（%）8（14.3）46（18.9）0.6630.415
心血管疾病史/例（%）20（35.7）89（36.6）0.0160.898
肝炎病史/例（%）3（5.4）10（4.1）0.1690.716
CCI/分（%）2.6930.285
1~23（5.4）8（3.3）
3~443（76.8）209（86.0）
5~610（17.9）26（10.7）
肿瘤位置/例（%）17.3020.016
舌16（28.6）100（41.2）
口底15（26.8）39（16.0）
牙龈9（16.1）11（4.5）
颌骨8（14.3）49（20.2）
颊部1（1.8）10（4.1）
腭部1（1.8）9（3.7）
口咽6（10.7）20（8.2）
其他0（0.0）5（2.1）
T分期/例（%）4.0410.133
1~219（38.0）82（37.8）
33（6.0）16（16.6）
428（56.0）99（45.6）
N分期/例（%）0.3820.826
N19（18.0）40（18.6）
N210（20.0）51（23.7）
否31（62.0）124（57.7）
ASA评分/例（%）2.6930.260
Ⅰ3（5.4）8（3.3）
Ⅱ43（76.8）209（86.0）
Ⅲ10（17.9）26（10.7）

表 2

2组患者术中特征及POP单因素分析"

变量POP组非POP组χ2/Z值P值
颌骨切除/例（%）43（76.8）146（60.1）5.4600.019
钛板钛钉植入/例（%）25（44.6）79（32.5）2.9530.086
颈部清扫/例（%）51（91.1）223（91.8）0.0290.793
皮瓣类型/例（%）1.2250.542
股前外侧皮瓣33（58.9）130（53.5）
前臂皮瓣17（30.4）73（30.0）
腓骨皮瓣6（10.7）40（16.5）
手术时间*/min490（425，578）470（414，526）-1.9100.056
围术期输血/例（%）20（35.7）37（15.2）12.381<0.001
手术当天液体输入量*/mL5 650（4 758，7 380）6 350（5 700，7 203）-2.4340.015
手术当天液体出量*/mL3 557（2 671，4 372）3 471（2 700，4 250）-0.0160.987
术中麻醉时间*/h8.75（7.67，10.00）8.33（7.40，9.25）-2.1110.035
术中用地塞米松/例（%）23（41.1）164（67.5）13.559<0.001
术中用多巴胺/例（%）5（8.9）18（7.4）0.0110.915
术中用去甲肾上腺素/例（%）6（10.7）16（6.6）0.6140.433
术中用血管吻合器/例（%）22（39.3）169（69.5）18.063<0.001
吻合静脉数量/例（%）26.058<0.001
1根24（58.5）187（89.9）
2根17（41.5）21（10.1）
术中使用抗生素/例（%）49（87.5）220（90.5）0.4640.496
术中气管切开/例（%）42（75.0）233（95.9）24.135<0.001

表 3

2组患者术后特征及POP单因素分析"

变量POP组非POP组χ2/Z值P值
术后住院时间*/d22（18，27）19（16，25）-5.986<0.001
入住ICU/例（%）42（75.0）85（35.0）29.833<0.001
ICU入住时间*/h43.00（23.25，66.50）40.00（18.25，60.75）-1.7790.075
机械通气/例（%）41（73.2）81（33.3）29.968<0.001
ICU机械通气时间*/h11.00（1.84，20.25）2.33（1.29，9.00）-2.5630.010
气管套管留置时间*/ d13.00（9.38，15.00）6.00（3.67，12.75）-4.891<0.001
术后抗生素种类/例（%）29.646<0.001
1~222（39.3）185（76.1）
325（44.6）50（20.6）
49（16.1）8（3.3）
术后抗生素使用时间*/d17（14，22）14（11，18）-5.983<0.001
术后两联抗生素使用时间*/d6（1，13）6（3，8）-0.1070.914

表 4

变量赋值"

变量赋值方式
气管套管留置时间原值代入
术中气管切开是=1；否=0
吻合静脉数量1根=1；2根=2
颌骨切除是=1；否=0
术后抗生素种类1~2种=1；3种=2；4种=3

表 5

口腔癌游离皮瓣重建患者气管切开后POP的多因素Logistic回归模型"

变量回归系数标准误Wald χ2值P值OR值95%CI
下限上限
气管套管留置时间0.0930.02811.2080.0011.0971.0391.158
术中气管切开-2.1170.54814.912<0.0010.1200.0410.353
吻合静脉数量1.2070.4278.0080.0053.3451.4497.719
颌骨切除0.8910.4134.6480.0312.4391.0845.484
术后抗生素种类24.977<0.001
1Ref
21.5140.40114.279<0.0014.5462.0739.972
32.6900.61619.069<0.00114.7324.40549.273
常数-2.2280.65311.6370.001

图1

口腔癌游离皮瓣重建患者气管切开后POP的决策树模型"

表 6

Logistic回归模型与决策树模型的效果比较"

模型AUC95%CI标准误P值
Logistic0.8440.784，0.9040.031<0.001
决策树0.8960.854，0.9370.021

图2

Logistic回归模型与决策树模型的ROC曲线对角段由绑定值生成。"

《Misch口腔种植并发症的预防与处理》出版发行"

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