基于决策树模型的胸腔镜下肺癌根治术患者术后麻醉恢复室低氧血症影响因素  

Influencing factors of PACU hypoxemia after thoracoscopic radical resection of lung cancer:A study based on the decision tree model

作　　者：杜文文 李鹏[1] 张玉[1] 李强[1] 张安琪[1] 刘雪娇 齐良 莫云长[1] DU Wenwen;LI Peng;ZHANG Yu;LI Qiang;ZHANG Anqi;LIU Xuejiao;QI Liang;MO Yunchang(Department of Anesthesiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325015

出　　处：《温州医科大学学报》2023年第6期473-481,共9页Journal of Wenzhou Medical University

基　　金：浙江省中医药科技计划项目(2023ZL086);温州市基础性科研项目(2021Y0335)。

摘　　要：目的:建立可预测胸腔镜下肺癌根治术后患者麻醉恢复室(PACU)发生低氧血症的决策树模型,并探讨其预测价值。方法:采用回顾性分析,选取2017年1月至2022年6月温州医科大学附属第一医院麻醉科择期行胸腔镜下肺癌根治术的5 560例患者为研究对象,根据是否并发PACU低氧血症将患者分为两组,分别为非低氧血症组和低氧血症组。基于决策算法建立预测模型并验证,分别绘制受试者工作特征曲线、校准曲线、决策曲线图。结果:5 560例患者中,1 653例(29.73%)患者出现PACU低氧血症。基于训练集建立的决策树模型结果决策树生长5层,共有8个终末节点,筛选出与术后PACU低氧血症相关的6个变量:年龄、性别、术中使用右美托咪定、地佐辛、手术时间、麻醉医师被接班。其中患者年龄≥64岁,女性,麻醉医师被接班,术中辅助使用地佐辛、右美托咪定,非上午手术为术后PACU低氧血症的促进因素,而男性、术中辅助使用氟比洛芬酯、上午手术是术后PACU低氧血症的保护因素(P<0.05)。采用验证集数据,对建立的决策树模型进行验证,结果显示AUC值为0.916,预测值与实测值有较好的一致性,模型具有良好的净获益。结论:基于决策树建立的胸腔镜下肺癌根治术患者PACU低氧血症的预测模型具有较好的预测能力、较高的准确性和良好的净获益,结构直观明了,有助于PACU医护人员早期识别和预防低氧血症。Objective:To establish a decision tree model that can predict hypoxemia in postanesthesia care unit of lung cancer patients undergoing thoracoscopic radical resection,and to explore predictive value of decision tree model.Methods:A retrospective study was conducted.5560 patients who underwent thoracoscopic radical resection of lung cancer in the Anesthesiology Department of the First Affiliated Hospital of Wenzhou Medical University were selected as the study objects from January 2017 to June 2022.According to whether hypoxemia was complicated in the PACU,the patients were divided into two groups:non-hypoxemia group and hypoxemia group.A prediction model was established and validated based on the decision algorithm,and receiver operator characteristic curve,calibration curve,and decision curve were draw,respectively.Results:Among 5560 patients,1653 patients developed hypoxemia in the PACU.The results of decision tree model analysis based on training sets showed that age,sex,intraoperative auxiliary use of dexmedetomidine,anesthesiologist’s shift,time of surgery,and intraoperative auxiliary use of diazosine were related to PACU hypoxemia after thoracoscopic radical resection of lung cancer(P<0.05).Among them,≥64 years old,female,the shift of anesthesiologist,intraoperative auxiliary use of diazosine,dexmedetomidine,and non-morning surgery were the promoting factors for postoperative PACU hypoxemia,while male,intraoperative auxiliary use of flurbiprofen axetil,and morning surgery were the protective factors for postoperative PACU hypoxemia(P<0.05).Decision tree model was validated by validation set data.The results showed that the AUC value was 0.916,and the predicted value was in good agreement with the measured value.The model had good net benefits.Conclusion:The prediction model for PACU hypoxemia in patients undergoing thoracoscopic radical resection of lung cancer based on decision tree algorithm has good predictive ability,high accuracy,good net benefit,and intuitive structure,which is helpful for PACU me

关 键 词：胸腔镜下肺癌根治术 麻醉后恢复室 低氧血症 决策树 

分 类 号：R614[医药卫生—麻醉学]