腰硬联合麻醉下凶险性前置胎盘剖宫产术低血压发生的诱导因素及列线图预测模型的构建  

Induction factors of hypotension during cesarean section for perilous placenta previa under combined spinal-epidural anesthesia and construction of a nomogram prediction model

作　　者：刘伟武[1] 曾伟兰[1] 徐秀英[1] 周树强[1] 梁妙 刘丽梅[1] 陈恒[1] LIU Weiwu;ZENG Weilan;XU Xiuying;ZHOU Shuqiang;LIANG Miao;LIU Limei;CHEN Heng(Department of Obstetrics,Yulin Maternity and Child Healthcare Hospital of Guangxi Zhuang Autonomous Region,Yulin,Guangxi,537000)

机构地区：[1]广西壮族自治区玉林市妇幼保健院产科,广西玉林537000

出　　处：《实用临床医药杂志》2024年第20期66-71,共6页Journal of Clinical Medicine in Practice

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-K20221825)。

摘　　要：目的探讨腰硬联合麻醉(CSEA)下凶险性前置胎盘剖宫产术中低血压发生的诱导因素并构建列线图预测模型。方法选取玉林市妇幼保健院2020年1月—2023年12月收治的腰硬联合麻醉(CSEA)下凶险性前置胎盘剖宫产术产妇130例作为研究对象,采用自编的一般资料调查表对研究对象基本资料及低血压发生情况进行调查,并依据术中低血压发生情况将其分为低血压组47例和无低血压组83例。对2组一般资料进行单因素分析,采用多因素Logistic回归分析法探讨术中发生低血压的诱导因素。结果单因素分析显示,2组体质量指数、麻醉平面情况、是否为多胎妊娠、术前收缩压情况、手术时间、是否出现Bezold-Jarisch反射比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,体质量指数≥24 kg/m^(2)、麻醉平面≥T8、多胎妊娠、术前收缩压<90 mmHg、手术时间>1.5 h、出现Bezold-Jarisch反射是CSEA下凶险性前置胎盘产妇剖宫产术中发生低血压的独立危险因素(P<0.05)。构建CSEA下凶险性前置胎盘剖宫产术中低血压发生的诱导因素回归方程:Logit(P)=-23.211+1.079×(体质量指数≥24 kg/m^(2))+1.101×麻醉平面(≥T8)+3.193×多胎妊娠+2.214×术前收缩压(<90 mmHg)+4.606×手术时间(>1.5 h)+2.011×出现Bezold-Jarisch反射。分析发现列线图对于存在术前收缩压<90 mmHg人群均有较高区分度及准确度;对列线图模型进行Bootstrap重复抽样1000次,获得校准曲线,计算得到的一致性指数为0.850,说明该列线图模型具备较好的校准度;绘制受试者工作特征(ROC)曲线,其曲线下面积为0.896,95%CI为0.802~0.956,提示预测效能较好。结论体质量指数≥24 kg/m^(2)、麻醉平面≥T8、多胎妊娠、术前收缩压<90 mmHg、手术时间>1.5 h、出现Bezold-Jarisch反射是CSEA下凶险性前置胎盘产妇剖宫产术中低血压发生的诱导因素。Objective To investigate the induction factors of hypotension during cesarean section for perilous placenta previa under combined spinal-epidural anesthesia(CSEA)and to construct a nomogram prediction model.Methods A total of 130 parturients who underwent cesarean section for perilous placenta previa under CSEA from January 2020 to December 2023 in Yulin Maternity and Child Healthcare Hospital were selected as study subjects.A self-designed general information questionnaire was used to investigate the basic information and the occurrence of hypotension of the subjects.According to the occurrence of intraoperative hypotension,the patients were divided into hypotension group(47 cases)and non-hypotension group(83 cases).Univariate analysis was performed on the general information of the two groups,and multivariate Logistic regression analysis was used to explore the induction factors of intraoperative hypotension.Results Univariate analysis showed that there were statistically significant differences in body mass index,anesthesia level,presence of multiple pregnancy,preoperative systolic blood pressure,operative time,and the occurrence of Bezold-Jarisch reflex between the two groups(P<0.05).Multivariate Logistic regression analysis revealed that body mass index≥24 kg/m^(2),anesthesia level was in the eighth thoracic vertebra(T8)or above,multiple pregnancy,preoperative systolic blood pressure<90 mmHg,operative time>1.5 h,and the occurrence of Bezold-Jarisch reflex were independent risk factors for hypotension during cesarean section for perilous placenta previa under CSEA(P<0.05).A regression equation for the induction factors of hypotension during cesarean section for perilous placenta previa under CSEA was constructed:Logit(P)=-23.211+1.079×(body mass index≥24 kg/m^(2))+1.101×anesthesia level(≥T8)+3.193×multiple pregnancy+2.214×preoperative systolic blood pressure(<90 mmHg)+4.606×operative time(>1.5 h)+2.011×occurrence of Bezold-Jarisch reflex.The nomogram showed high discrimination and accuracy for pat

关 键 词：凶险性前置胎盘 剖宫产 腰硬联合麻醉 低血压 诱导因素 预测价值 

分 类 号：R714.2[医药卫生—妇产科学] R614[医药卫生—临床医学] R319