组织工程与重建外科杂志

组织工程与重建外科杂志››2025,Vol. 21››Issue (4): 347-.

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游离皮瓣移植术后血运风险预警模型的构建及应用

    • 出版日期:2025-08-01发布日期:2025-09-08

    Construction and application of early warning model of blood circulation risk after free flap transplantation

      • Online:2025-08-01Published:2025-09-08

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      摘要：

      目的 探讨游离皮瓣移植术后血运风险因素，并构建相关预警模型，旨在为临床早期识别高危人群并及时救治提供参考。方法 纳入2011年1月至2024年1月于我院行游离皮瓣移植术的患者396例，其中276例进行预测模型构建（建模组），另120例进行内部验证（验证组）。根据术后72 h内有无发生血管危象分组，采用单因素和多因素法评估游离皮瓣移植术后血管危象独立风险因素，进一步构建早期预警模型并分析临床预测效能。结果 建模组纳入276例患者，术后发生血管危象27例，发生率为9.78%。单因素分析结果显示，是否合并2型糖尿病、有无吸烟史、术后24 h疼痛视觉模拟评分、术后即刻体温、术后摆放体位及术后是否使用扩血管药物等，均可能与游离皮瓣移植术后血管危象发生有关（P＜0.05）。多因素分析结果显示，合并 2 型糖尿病、吸烟史、术后 24 h 疼痛视觉模拟评分≥7 分、术后即刻体温＜34 ℃、术后患侧卧位及术后使用扩血管药物等，均是游离皮瓣移植术后血管危象发生的独立危险因素（P＜0.05）。根据多因素分析结果建立游离皮瓣移植术后血管危象发生风险回归预测方程，即发生风险Logit（Y）=0.72+1.70×合并2型糖尿病+0.81×吸烟史+0.63×术后24 h疼痛视觉模拟评分≥7分+0.88×术后即刻体温＜34 ℃+0.52×术后患侧卧位+0.46×术后使用扩血管药物；ROC曲线分析结果显示，上述线性回归预测方程用于游离皮瓣移植术后血管危象发生风险预测AUC为0.87（95%CI：0.83~0.95），在截断值为2.87时灵敏度和特异度分别为87.40%和82.97%。结论 游离皮瓣移植术后血管危象可能与是否合并2型糖尿病、有无吸烟史、术后24 h疼痛视觉模拟评分、术后即刻体温、术后摆放体位及术后是否使用扩血管药物有关，而基于上述因素的有关预警模型具有良好临床预测效能。

      关键词:

      Abstract:Objective To investigate the risk factors for blood circulation risk after free flap transplantation and construct
      early warning model to provide reference for the early identification and prevention of high-risk groups in subsequent clinical practice. Methods From January 2011 to January 2024，396 patients underwent free skin flap transplantation in our hospital were included：276 cases underwent predictive model construction （modeling group） and 120 cases underwent internal validation （validation group）. The patients were grouped according to whether vascular crisis occurred within 72 h after surgery， and the independent risk factors of vascular crisis after free skin flap transplantation were evaluated by single factor and multivariate method， and the early warning model was further constructed and the clinical prediction efficiency was analyzed. Results There were 27 cases developed vascular crisis after surgery in all 276 patients （modeling group） with the ncidence of 9.78%. The results of univariate analysis showed that type 2 diabetes， smoking history，24 h postoperative visual analogue score of pain， immediate postoperative body temperature， postoperative position and postoperative use of vasodilators may be related to the occurrence of vascular crisis after free flap transplantation （P<0.05）. The results of
      multivariate analysis showed that type 2 diabetes mellitus， smoking history， pain visual analogue score ≥7 in 24 h after surgery，immediate postoperative body temperature <34 ℃， lateral position and vasodilator were independent risk factors for vascular crisis after free flap transplantation （P<0.05）. Based on the results of multi-factor analysis， the regression prediction equation for the risk of vascular crisis after free flap transplantation was established. That is， the risk Logit （Y）=0.72+1.70×combined type 2 diabetes+0.8×smoking history+0.63×pain visual analogue score≥7 points at 24 h after surgery+0.88×immediate postoperative body temperature<34 ℃ +0.52×placement of the affected lateral position+0.46×use of vasodilators after surgery. ROC curve analysis

      results showed that the AUC for predicting the risk of vascular crisis after free flap transplantation was 0.87（95%CI：0.83-0.95），and the sensitivity and specificity were 87.40% and 82.97%， respectively， when the cut-off value was 2.87. Conclusion Vascular crisis after free flap transplantation may be related to type 2 diabetes mellitus， smoking history， pain visual analog score 24 h after surgery， immediate postoperative body temperature， postoperative position， and the use of vasodilators after surgery.Based on these factors， the early warning model has satisfactory clinical prediction efficacy.

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