全身麻醉下经内镜逆行胰胆管造影术中低体温预测危险因素的研究  

Predictive Risk Factors for Intraoperative Hypothermia During Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia

作　　者：龚晓媛 王旭 陆伦根[1] 罗声政[1] 傅承宏 李百文[1] 万舒淇 GONG Xiaoyuan;WANG Xu;LU Lungen;LUO Shengzheng;FU Chenghong;LI Baiwen;WAN Shuqi(Department of Gastroenterology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,201620;Department of Gastroenterology,People’s Hospital of Zunyi City Bozhou District,Zunyi,Guizhou Province)

机构地区：[1]上海交通大学医学院附属第一人民医院消化内科,201620 [2]贵州省遵义市播州区人民医院消化内科

出　　处：《胃肠病学》2022年第11期641-645,共5页Chinese Journal of Gastroenterology

摘　　要：背景:术中意外低体温是全身麻醉手术的常见并发症,可引起疼痛、凝血功能障碍、伤口感染、延迟康复等不良后果。目前鲜有经内镜逆行胰胆管造影(ERCP)术中低体温的相关研究。目的:分析全身麻醉下ERCP术中低体温的危险因素,并建立预测模型。方法:选取2021年9月—2021年11月在上海市第一人民医院行全身麻醉下ERCP的患者121例,收集相关临床资料,采用Logistic回归分析筛选危险因素,构建预测模型,使用独立数据集通过ROC曲线和Hosmer⁃Lemeshow拟合优度检验对模型进行外部验证。结果:共114例患者纳入建模组,术中低体温发生率为11.40%(13/114)。低体温组中女性患者明显增多(P<0.05),入手术室体温和手术室温度明显降低(P<0.05),其中性别是全身麻醉下ERCP发生术中低体温的独立危险因素(P<0.05)。采用Logistic回归分析筛选出的性别和入手术室体温构建的预测模型具有较好的区分度和校准度,外部验证的ROC曲线下面积为0.78。结论:性别和入手术室体温可较好地预测ERCP术中低体温的发生,可协助围手术期的监护管理。Background:Unintended intraoperative hypothermia is a common complication of general anesthesia surgery,which can cause pain,coagulation dysfunction,wound infection,delayed recovery,and other adverse consequences.There are few studies related to intraoperative hypothermia during endoscopic retrograde cholangiopancreatography(ERCP).Aims:To analyze the risk factors of intraoperative hypothermia during ERCP under general anesthesia and establish a predictive model.Methods:A total of 121 patients underwent ERCP under general anesthesia from September 2021 to November 2021 at Shanghai General Hospital were recruited,and relevant clinical data were collected.Logistic regression analysis was used to screen risk factors,and a predictive model was constructed.The model was externally validated by independent datasets with ROC curve and Hosmer⁃Lemeshow goodness of fit test.Results:A total of 114 patients were enrolled in modeling group.The incidence of intraoperative hypothermia was 11.40%(13/114).There were more women in the hypothermia group(P<0.05).The temperature of entering the operating room and operating room temperature were relatively lower in the hypothermia group(P<0.05).Gender was an independent risk factor for intraoperative hypothermia in ERCP under general anesthesia(P<0.05).The predictive model constructed by using gender and temperature of entering the operating room screened by Logistic regression analysis had a good discrimination and calibration,area under the ROC curve by external validation was 0.78.Conclusions:Gender and temperature of entering the operating room can effectively predict the occurrence of intraoperative hypothermia and assist perioperative monitoring and management.

关 键 词：术中低体温 麻醉 全身 胰胆管造影术 内镜逆行 危险因素 预测模型 

分 类 号：R614[医药卫生—麻醉学]