急性结石性胆囊炎腹腔镜胆囊切除中转开腹患者术中低体温风险预警模型的构建与验证  

Construction and verification of intraoperative hypothermia risk early warning model for patients undergoing conversion to laparotomy from laparoscopic cholecystectomy for acute calculous cholecystitis

作　　者：陈一楠 谢晓波 黄银芳 谢小华 CHEN Yinan;XIE Xiaobo;HUANG Yinfang(Operating Room,Zhejiang Shaoxing Hospital of Integrated Traditional Chinese and Western Medicine,Shaoxing 312000,China;Department of Surgery,Zhejiang Shaoxing Hospital of Integrated Traditional Chinese and Western Medicine)

机构地区：[1]绍兴市中西医结合医院手术室,浙江绍兴312000 [2]绍兴市中西医结合医院外科

出　　处：《腹腔镜外科杂志》2024年第10期747-752,757,共7页Journal of Laparoscopic Surgery

摘　　要：目的:探讨急性结石性胆囊炎腹腔镜胆囊切除中转开腹患者术中发生低体温的影响因素,基于独立危险因素构建并验证风险预测模型。方法:回顾性选取2019年1月至2023年12月收治的114例急性结石性胆囊炎行腹腔镜胆囊切除术中转开腹患者作为建模组,按6∶4比例纳入76例急性结石性胆囊炎腹腔镜胆囊切除术中转开腹患者作为验证组。根据建模组中患者是否发生低体温分为发生组与未发生组,通过单因素分析与多因素Logistic回归分析得出独立危险因素,并构建风险预测模型,使用R语言软件绘制相应的列线图,采用受试者工作特征曲线、校准曲线检验预测效能。采用验证集的数据对模型的预测效能进行外部验证。结果:建模组患者中30例发生低体温(发生组),84例未发生低体温(未发生组),发生率为26.32%。多因素Logistic回归分析结果显示,年龄、麻醉方式、手术时间、术中补液量、术中冲洗液量、术中出血量、无主动保温措施均是急性结石性胆囊炎腹腔镜胆囊切除中转开腹患者发生术中低体温的独立危险因素(OR>1,P<0.05),BMI是独立保护因素(OR<1,P<0.05)。基于以上独立影响因素构建的风险预测模型曲线下面积为0.969,对应的敏感度、特异度分别为93.9%与91.7%,校准曲线较为接近理想曲线,平均绝对误差为0.036。验证集的曲线下面积为0.970,对应的敏感度、特异度分别为94.7%与91.2%,校准曲线平均绝对误差为0.058。结论:急性结石性胆囊炎腹腔镜胆囊切除中转开腹患者术中发生低体温受年龄、BMI、麻醉方式、手术时间、术中补液量、术中冲洗液量、术中出血量、主动保温措施影响,基于以上因素构建的风险预测模型具有良好的预测效能,可为预测并干预术中低体温提供参考。Objective:To investigate the influencing factors of intraoperative hypothermia in patients with acute calculous cholecystitis undergoing laparoscopic cholecystectomy(LC)converted to laparotomy,and to construct and validate a risk prediction model based on independent risk factors.Methods:Retrospectively,114 patients with acute calculous cholecystitis who underwent LC converted to laparotomy from Jan.2019 to Dec.2023 were selected as the modeling group,and an additional 76 patients were included as the validation group in the ratio of 6∶4.According to whether hypothermia occurred in the modeling group,the patients were divided into o ccurrence group and non-occurrence group.The independent risk factors were obtained by univariate analysis and multivariate logistic regression analysis,and a risk prediction model was constructed.R software was used to draw corresponding nomogram.Receiver operating characteristic curve and calibration curve were used to test the prediction efficiency.The data of the validation set were used for e xternal verification of the prediction efficacy of the model.Results:Of the 114 patients in the modeling group,hypothermia occurred in 30(occurrence group)and the other 84 did not experience hypothermia(non-occurrence group),with an incidence of 26.32%.Multivariate logistic regression analysis showed that age,anesthesia method,surgical time,intraoperative fluid infusion volume,intraoperative irrigation fluid volume,intraoperative bleeding,and absence of active warming measures were independent risk factors for intraoperative hypothermia in patients undergoing LC converted to laparotomy for acute calculous cholecystitis(OR>1,P<0.05),and BMI was an i ndependent protective factor(OR<1,P<0.05).The area under the curve of the risk prediction model based on the above independent influencing factors was 0.969,and the corresponding sensitivity and specificity were 93.9%and 91.7%,respectively.The calibration curve was close to the ideal curve,and the mean absolute error was 0.036.The area under the

关 键 词：急性结石性胆囊炎 胆囊切除术 腹腔镜 中转开腹手术 低体温 预测模型 

分 类 号：R657.41[医药卫生—外科学]