麻醉复苏室全麻患者院内转运脉搏血氧饱和度下降风险预测模型的构建与验证  

Construction and validation of a risk prediction model for oxygen saturation drop during intra-hospital transport in patients after general anesthesia

作　　者：张子贤 吕桂萍[1] 邓雪琴[1] 张悦 金瑛 ZHANG Zixian;LYU Guiping;DENG Xueqin;ZHANG Yue;JIN Ying(Department of Anesthesia and Surgery Center,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China)

机构地区：[1]杭州市中医院麻醉手术中心,310007 [2]杭州市中策职业学校钱塘学校 [3]浙江中医药大学附属第二医院护理部

出　　处：《浙江医学》2024年第23期2503-2509,共7页Zhejiang Medical Journal

摘　　要：目的构建预测麻醉复苏室(PACU)全麻患者转运脉搏血氧饱和度(SpO_(2))下降风险的列线图模型并进行临床评价,以期做到早期识别、降低转运危险。方法回顾性选取2021年3至9月浙江中医药大学附属第二医院791例PACU全麻患者作为建模组,2021年9月至2024年6月浙江中医药大学附属第二医院及杭州市中医院共419例PACU全麻患者作为验证组。根据SpO_(2)下降是否>5%进行分组,采用单因素分析、多因素logistic回归筛选PACU全麻患者发生SpO_(2)下降的独立影响因素,并构建预测模型,采用R软件绘制列线图并作验证。结果SpO_(2)下降发生率为29.1%,最终进入模型的影响因素有年龄、BMI、吸烟史、从手术室转运到PACU SpO_(2)下降情况、在PACU吸氧、早期预警评分、Ramsay镇静评分、PACU滞留时间、转运时间、转运人员职称、转运过程中与患者沟通。建模组的AUC、灵敏度、特异度、约登指数分别为0.878、0.822、0.793、0.615;验证组模型准确率为80.19%。结论列线图模型区分度、校准度较好,对识别PACU全麻院内转运患者发生SpO_(2)下降的风险有一定指导意义。Objective To develop and validate a nomogram model for predicting the risk of hypoxemia for patients in the post-anesthesia care unit(PACU).Methods A total of 791 PACU patients after general anesthesia at Second Affiliated Hospital of Zhejiang Chinese Medical University from March to September 2021 were selected as the training group,and 419 PACU patients at Second Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Hospital of Traditional Chinese Medicine from September 2021 to June 2024 were selected as the validation group.Patients were grouped based on whether their percutaneous blood oxygen saturation(SpO_(2))decreased by more than 5%.The risk factors of SpO_(2) decline were determined by univariate and multivariate logistic regression analysis.A nomogram was developed based on the identified risk factors and validated using R software.Results The incidence of decreased SpO_(2) was 29.1%.The multivariate logistic regression analysis showed that age,BMI,smoking history,SpO_(2) decline during transfer,oxygen therapy in the PACU,early warning score,Ramsay sedation score,length of PACU stay,transfer duration,professional titles of transfer personnel,and communication with patients during transfer were risk factors of declined SpO_(2) in PACU patients.For the training group,the area under the ROC curve(AUC),sensitivity,specificity,and Youden index were 0.878,0.822,0.793,and 0.615,respectively.For the validation group the accuracy of the model was 80.19%.Conclusion The nomogram model developed in this study exhibits good performance in predicting the risk of SpO_(2) decline for patients in the PACU.

关 键 词：麻醉复苏室 转运 血氧饱和度 危险因素 列线图 

分 类 号：R614[医药卫生—麻醉学]