达芬奇机器人辅助腹腔镜胰腺癌手术患者术后意外低体温影响因素分析  

Influencing factors of unexpected postoperative hypothermia in patients undergoing da Vinci robot-assisted laparoscopic surgery for pancreatic cancer

作　　者：牛婷 陆梁梁 李佳霖 许涛[2] 代元强 NIU Ting;LU Liangliang;LI Jialin;XU Tao;DAI Yuanqiang(Operating Room,Department of Anesthesiology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Anesthesiology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院麻醉科手术室,上海200433 [2]海军军医大学(第二军医大学)第一附属医院麻醉科,上海200433

出　　处：《海军军医大学学报》2024年第3期290-297,共8页Academic Journal of Naval Medical University

基　　金：海军军医大学(第二军医大学)第一附属医院“234学科攀峰计划”(2019YXK022)。

摘　　要：目的探讨行达芬奇机器人辅助腹腔镜胰腺癌根治手术的患者发生术后意外低体温(UPH)的危险因素,构建风险预测模型并评价其预测效能。方法选取2020年12月至2021年12月在海军军医大学(第二军医大学)第一附属医院接受达芬奇机器人辅助腹腔镜胰腺癌根治手术的患者作为研究对象,根据UPH的发生情况将患者分为UPH组和非UPH组。比较两组患者的一般资料(年龄、性别、美国麻醉医师学会分级、BMI、术前血红蛋白、术前白蛋白、基础体温)、手术资料(手术方式、神经阻滞类型、麻醉时间、手术时间、人工气腹建立时间、术后体温、术后并发症、院内转归)、围手术期液体管理资料(晶体液、胶体液、红细胞悬液、新鲜冰冻血浆、失血量、尿量)。采用logistic回归方法构建UPH预测模型,绘制ROC曲线和决策曲线评价模型预测UPH的效能,并建立列线图模型。结果共纳入患者246例,其中117例(47.6%)发生UPH。两组患者的BMI(P=0.047)、术前血浆白蛋白水平(P=0.038)、术后肺部并发症(PPC,P=0.039)、非肺部术后感染(NPPI,P=0.018)、总住院时间(P=0.001)、手术方式(P=0.042)、手术时间(P=0.038)、术中人工气腹建立时间(P=0.004)、神经阻滞类型(P=0.004)、术后体温(P<0.001)比较差异均有统计学意义。logistic回归分析结果显示达芬奇机器人辅助术式(OR=9.369,95%CI 2.528~34.717,P=0.001)、BMI(OR=0.787,95%CI 0.687~0.902,P=0.001)、手术时间(OR=0.040,95%CI 0.009~0.183,P<0.001)、人工气腹建立时间(OR=15.608,95%CI 3.814~63.870,P<0.001)、输液速率(OR=0.808,95%CI 0.706~0.924,P=0.002)、输液总量(OR=3.431,95%CI 1.480~7.956,P=0.004)及神经阻滞类型(OR=0.240,95%CI 0.131~0.443,P<0.001)与UPH的发生具有独立相关性。ROC曲线的AUC值为0.739,预测发生UPH的灵敏度为0.778,特异度为0.628。决策曲线分析结果表明预测模型具有较好的临床净收益。结论BMI低、输液速率慢、输液总量大、�Objective To investigate the risk factors of unexpected postoperative hypothermia(UPH)in patients undergoing da Vinci robot-assisted laparoscopic surgery for pancreatic cancer,construct a risk prediction model,and evaluate its prediction efficacy.Methods Patients who received da Vinci robot-assisted laparoscopic radical surgery for pancreatic cancer in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Dec.2020 to Dec.2021 were enrolled.According to the development of UPH,the patients were divided into UPH group and non-UPH group,and the general data(age,gender,American Society of Anesthesiologists classification,body mass index[BMI],preoperative hemoglobin,preoperative albumin,and basal body temperature),surgical data(operation mode,type of nerve block,anesthesia time,surgical time,artificial pneumoperitoneum time,postoperative body temperature,postoperative complications,and in-hospital outcomes),and perioperative fluid management data(crystal fluid,colloid fluid,red blood cell suspension,fresh frozen plasma,blood loss,and urine volume)were compared.Logistic regression was used to construct a UPH prediction model,receiver operating characteristic(ROC)curves and decision curves were drawn to evaluate the effectiveness of the model in predicting UPH,and a nomograph model was established.Results A total of 246 patients were enrolled,of whom 117(47.6%)developed UPH.There were significant differences in BMI(P=0.047),preoperative plasma albumin(P=0.038),postoperative pulmonary complications(P=0.039),non-pulmonary postoperative infection(P=0.018),total length of stay(P=0.001),operation mode(P=0.042),operation time(P=0.038),intraoperative of artificial pneumoperitoneum time(P=0.004),type of nerve block(P=0.004)and postoperative body temperature(P<0.001)between the 2 groups.Logistic regression analysis showed that da Vinci robot-assisted surgery(odds ratio[OR]=9.369,95%confidence interval[CI]2.528-34.717,P=0.001),BMI(OR=0.787,95%CI 0.687-0.902,P=0.001),operation time(OR=0.0

关 键 词：胰腺肿瘤 机器人辅助腹腔镜胰腺癌手术 手术后意外低体温 手术后并发症 麻醉 危险因素 

分 类 号：R735.9[医药卫生—肿瘤]