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目的:探讨个体化预测早期消化道肿瘤患者内镜黏膜下剥离术(ESD)术后迟发性出血的风险因素,建立列线图模型,并提出护理对策。方法:回顾性分析2017年12月—2019年12月因早期消化道肿瘤于泰州市人民医院行ESD治疗的236例患者资料,分别使用单因素和二分类Logistic回归分析术后发生迟发性出血的独立危险因素并建立列线图预测模型。结果:长期使用抗血栓药物(n OR=4.990)、活检次数≥3次(n OR=7.834)、伴溃疡和瘢痕(n OR=6.079)、病变直径≥3 cm(n OR=5.316)、浸润至黏膜下层(n OR=5.667)、术中明显出血(n OR=5.745)及术者经验(n OR=7.660)是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素(n P<0.05)。基于以上7项独立危险因素建立相关列线图预测模型,并对该模型进行验证,n H-n L偏差度检验结果为χn 2=3.753,n P=0.663,n C-n index为0.907(95%置信区间0.877~0.937),说明列线图预测模型具有良好的精准度和区分度。n 结论:长期使用抗血栓药物、活检次数≥3次、伴溃疡和瘢痕、病变直径≥3 cm、浸润至黏膜下层、术中明显出血及手术者不熟练是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素,建立的列线图模型具有准确的预测能力和区分度,有利于护理人员筛查高风险患者并制订相关护理对策。“,”Objective:To explore risk factors of individually predicting delayed bleeding after endoscopic submucosal dissection (ESD) for patients with early gastrointestinal tumors, to establish Nomogram model and to propose nursing countermeasures.Methods:Data of 236 patients who received ESD in Jiangsu Taizhou People's Hospital due to early gastrointestinal tumor from December 2017 to December 2019 were retrospectively analyzed. The independent risk factors for postoperative delayed bleeding were analyzed by univariate Logistic regression and binary Logistic regression respectively and a Nomogram prediction model was established.Results:Long-term use of antithrombotic drugs (n OR=4.990) , the number of biopsies greater or equal to 3 (n OR=7.834) , accompanied by ulcers and scars (n OR=6.079) , lesion diameter greater or equal to 3 cm (n OR=5.316) , infiltration to submucosa (n OR=5.667) , intraoperative marked bleeding (n OR=5.745) and experience of surgeons (n OR=7.660) were independent risk factors for delayed bleeding after ESD in early gastrointestinal tumors (n P<0.05) . A related Nomogram prediction model was established based on the above 7 independent risk factors, and the model was verified. Then H-n L deviation test result was χ n 2=3.753, n P=0.663 and n C-n index was 0.907 (95%n CI 0.877-0.937) , which indicated Nomogram prediction model had good accuracy and dipartite degree.n Conclusions:Long-term use of antithrombotic drugs, the number of biopsies greater or equal to 3, accompanied by ulcers and scars, lesion diameter greater or equal to 3 cm, infiltration to submucosa, intraoperative marked bleeding and unskilled surgeons are independent risk factors for delayed bleeding after ESD in early gastrointestinal tumors. Nomogram model established has accurate predictive ability and dipartite degree, which is helpful for nursing staff to screen high-risk patients and formulate relevant nursing strategies.