腹部消化系统手术患者术中低体温风险预测模型的构建与验证  

Establishment of risk prediction model for intraoperative hypothermia in patients undergoing abdominal surgery of digestive system and its validation

作　　者：方敏[1,2] 高兴莲 柯稳 王曾妍 梁元元 FANG Min;GAO Xing-lian;KE Wen;WANG Ceng-yan;LIANG Yuan-yuan(Operating Room,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;School of Nursing,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属协和医院手术室,湖北武汉430022 [2]华中科技大学同济医学院护理学院,湖北武汉430030

出　　处：《护理学报》2023年第20期58-63,共6页Journal of Nursing（China）

基　　金：湖北省自然科学基金(2020CFB776)。

摘　　要：目的探索腹部消化系统手术患者术中低体温的影响因素,构建预测模型,并对其预测效果进行检验。方法使用方便抽样法,抽取我院2021年12月—2022年7月的395例接受腹部消化系统手术患者,根据手术过程中是否发生低体温分为低体温组(n=242)和非低体温组(n=153)。根据Logistic回归结果确定术中低体温影响因素,建立风险预测模型并绘制列线图,对模型进行区分度、校准度及临床有效性评价检验。结果最终纳入手术间洁净度、手术分级、麻醉时间和手术开始时患者基础体温作为模型构建指标。模型最佳截断值为0.477时,ROC曲线下面积为0.901,灵敏性为0.793,特异性为0.830,约登指数为0.623,预测模型区分度较好;Hosmer-Lemeshow检验结果χ2=3.938,P=0.863,预测模型校准度较好;DCA决策曲线显示,该模型临床有效性较好。结论构建的术中低体温风险预测模型对腹部消化系统手术患者术中低体温的发生具有较高的预测价值,可为手术团队人员对高风险患者及时采取低体温防治措施提供依据。Objective To explore the factors influencing intraoperative hypothermia in patients undergoing abdominal surgery for digestive system,and to develop a risk prediction model and access its validity.Methods A total of 395 patients undergoing abdominal surgery for digestive system in our hospital from December 2021 to July 2022 were enrolled and allocated into hypothermia group(n=242)and non-hypothermia group(n=153)based on whether hypothermia occurred.The factors influencing intraoperative hypothermia were determined by logistic regression,and a risk prediction model was developed and plotted in a nomogramm,and the discrimination,calibration and clinical validity of the model were assessed.Result Four factors of the cleanliness of operating room,operation grade,anesthesia time and basic body temperature at the beginning of the operation were included in the model.When the best cut-off value of the model was 0.477,the area under the ROC curve was 0.901 with the sensitivity and the specificity of 0.793 and 0.830 respectively while the Youden index 0.623,showing that the prediction model was well differentiated.Hosmer-Lemeshow test showedχ2=3.938,P=0.863,indicating that prediction model was well calibrated.Decision curve analysis showed that the model has clinical effectiveness.Conclusion The constructed risk prediction model is of high value in predicting the occurrence of intraoperative hypothermia in patients undergoing abdominal surgery of digestive system.It provides reference for surgical team to take timely measures to prevent hypothermia for high-risk patients.

关 键 词：低体温 腹部消化系统手术 影响因素 风险预测 手术室护理 

分 类 号：R473.6[医药卫生—护理学]