基于多因素logistic回归方法建立老年患者全身麻醉术后恢复期不良事件发生的预测模型  

Prediction model based on multivariate logistic regression method for adverse events during the recovery period after general anesthesia in elderly patients

作　　者：刘晶晶 常浩生[2] 李春喜 王小华[3] 杨迎春 Liu Jingjing;Chang Haosheng;Li Chunxi;Wang Xiaohua;Yang Yingchun(Department of Anesthesiology,Chinese People’s Armed Police Force Hospital of Beijing,Beijing 100027,China;Department of Surgery,Chinese People’s Armed Police Force Hospital of Beijing,Beijing 100027,China;Department of Anesthesiology,Xuanwu Hospital Capital Medical University,Beijing 100053,China;Department of Anesthesiology,Beijing Fengtai Hospital,Beijing 100071,China)

机构地区：[1]中国人民武装警察部队北京市总队医院麻醉科,北京100027 [2]中国人民武装警察部队北京市总队医院普外科,北京100027 [3]首都医科大学宣武医院麻醉科,北京100053 [4]北京丰台医院麻醉科,北京100071

出　　处：《中国医刊》2024年第5期524-528,共5页Chinese Journal of Medicine

基　　金：北京市属医学科研院所公益发展改革试点项目(京医研2019-2)。

摘　　要：目的 基于多因素logistic回归方法建立老年患者全身麻醉术后恢复期不良事件发生的预测模型。方法 回顾性分析2021年9月至2022年9月在首都医科大学宣武医院进行全身麻醉手术的356例老年患者的临床资料,根据术后恢复期是否发生不良事件将研究对象分为无不良事件组(未发生不良事件,274例)和不良事件组(发生不良事件,82例)。比较分析两组患者的临床资料。采用多因素logistic回归方法分析老年患者全身麻醉术后恢复期不良事件发生的独立危险因素。采用R软件建立列线图模型;采用受试者操作特征(ROC)曲线分析列线图模型对老年患者全身麻醉术后恢复期不良事件发生的预测价值。结果 82例老年患者全身麻醉术后恢复期发生不良事件,发生率为23.0%。不良事件组患者年龄≥70岁的比例、麻醉时间≥120 min的比例、手术时间≥140 min的比例、谷丙转氨酶≥80 U/L的比例、血肌酐≥264μmol/L的比例、C反应蛋白≥15 mg/L的比例、中性粒细胞与淋巴细胞比值(NLR)≥5的比例均高于无不良事件组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄≥70岁、麻醉时间≥120 min、手术时间≥140 min、血肌酐≥264μmol/L、C反应蛋白≥15 mg/L、NLR≥5均为老年患者全身麻醉术后恢复期不良事件发生的独立危险因素(P<0.05)。以年龄、麻醉时间、手术时间、血肌酐、C反应蛋白、NLR为自变量,通过R软件构建老年患者全身麻醉术后恢复期不良事件发生的列线图模型,ROC曲线分析结果显示,列线图模型预测老年患者全身麻醉术后恢复期不良事件发生的曲线下面积为0.787,敏感度为74.4%,特异度为70.8%。结论 老年患者全身麻醉术后恢复期不良事件的发生率仍较高,年龄≥70岁、麻醉时间≥120 min、手术时间≥140 min、血肌酐≥264μmol/L、C反应蛋白≥15 mg/L、NLR≥5均为老年患者全身麻醉术后�Objective To establish a prediction model based on multivariate logistic regression method for adverse events during the recovery period after general anesthesia in elderly patients.Method Clinical data of 356 elderly patients undergoing general anesthesia surgery in Xuanwu Hospital Capital Medical University from September 2021 to September 2022 were retrospectively analyzed.According to whether adverse events occurred during the postoperative recovery period,the subjects were divided into no adverse event group(without adverse events,274 cases) and adverse event group(with adverse events,82 cases).The clinical data in the two groups were compared and analyzed.To analyze the independent factors inf luencing the occurrence of adverse events during the recovery period after general anesthesia in elderly patients.To establish a nomogram model for the occurrence of adverse events during the recovery period after general anesthesia in elderly patients.To analyze the value of the nomogram model in predicting the occurrence of adverse events after general anesthesia in elderly patients.Result Adverse events occurred in 82 elderly patients during the recovery period after general anesthesia,with the incidence of 23.0%.The proportion of age≥70 years old,anesthesia time≥120 min,operation time≥140 min,alanine transaminase≥80 U/L,serum creatinine≥264 μmol/L,C-reactive protein≥15 mg/L,NLR≥5in the adverse event group were higher than those in the no adverse event group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that age≥70 years old,anesthesia time≥120 min,operation time≥140 min,serum creatinine≥264 μmol/L,C-reactive protein≥15 mg/L and NLR≥5 were independent risk factors for adverse events during the recovery period after general anesthesia in elderly patients(P<0.05).With age,anesthesia time,operation time,serum creatinine,C-reactive protein and NLR as independent variables,a nomogram model of adverse events occurring during the rec

关 键 词：老年 全身麻醉 不良事件 危险因素 列线图模型 

分 类 号：R614[医药卫生—麻醉学]