剖宫产产妇麻醉后发生低血压的影响因素分析及列线图模型构建  

Influencing factors of hypotension after anesthesia in women taking cesarean section and construction of nomagram model

作　　者：聂清华 李晓龙 朱博 代志明 Nie Qinghua;Li Xiaolong;Zhu Bo;Dai Zhiming(Department of Anesthesiology,Xianyang First People's Hospital,Xianyang 712000,China)

机构地区：[1]咸阳市第一人民医院麻醉科,咸阳712000

出　　处：《国际医药卫生导报》2025年第4期627-632,共6页International Medicine and Health Guidance News

基　　金：陕西省重点研发计划(2024SF-YBXM-009)。

摘　　要：目的探讨剖宫产产妇麻醉后发生低血压的影响因素,并构建列线图模型。方法采用回顾性研究,选取2022年4月至2024年6月在咸阳市第一人民医院行剖宫产手术的269例产妇临床资料,按麻醉后低血压发生情况,将出现低血压的119例产妇归为低血压组,未出现低血压的150例产妇归为非低血压组。低血压组:年龄(31.56±4.28)岁,孕周(39.05±1.23)周;美国麻醉医师协会(ASA)分级:Ⅰ级80例,Ⅱ级39例。非低血压组:年龄(30.69±4.03)岁,孕周(38.84±0.96)周;ASA分级:Ⅰ级115例,Ⅱ级35例。比较两组临床资料,采用多因素logistic回归分析筛查剖宫产产妇麻醉后发生低血压的影响因素,使用R软件和rms程序包构建麻醉后低血压的风险预测列线图模型,利用校准曲线、受试者操作特征曲线(ROC)和决策分析曲线对该模型的临床应用价值进行验证。统计学方法采用t检验、χ^(2)检验。结果低血压组产妇腹围>100 cm、宫高>36 cm、麻醉平面>T4占比及术中出血量均高于非低血压组[89.08%(106/119)比80.00%(120/150)、11.76%(14/119)比4.00%(6/150)、20.17%(24/119)比8.67%(13/150)、(326.52±65.39)ml比(301.43±62.68)ml,差异均有统计学意义(χ^(2)=4.070、5.813、7.399,t=3.199,均P<0.05);低血压组产前血红蛋白水平和体位左侧倾斜、预防性用药占比均低于非低血压组[(125.95±13.46)g/L比(132.53±12.68)g/L、71.43%(85/119)比88.67%(133/150)、56.30%(67/119)比76.67%(115/150)],差异均有统计学意义(t=4.113,χ^(2)=12.833、12.576,均P<0.05)。多因素logistic回归分析显示宫高>36 cm、产前血红蛋白低、术中出血量大、麻醉平面>T4均是剖宫产产妇麻醉后发生低血压的危险因素[比值比(OR)=1.808、1.906、1.866、2.268,均P<0.05],体位左侧倾斜、预防性用药是其保护因素(OR=0.510、0.490,均P<0.05)。列线图模型经内部验证显示一致性指数为0.868,校准曲线显示校正曲线与理想曲线相贴近,ROC显示其灵敏度、特异度�Objective To explore the influencing factors of hypotension after anesthesia in women taking cesarean section,and to construct a nomagram model.Methods The clinical data of 269 women who underwent cesarean section at Xianyang First People's Hospital from April 2022 to June 2024 were retrospectively analyzed.According to whether they had hypotension after anesthesia,they were divided into a hypotension group(119 cases)and a non-hypotension group(150 cases).The hypotension group were(31.56±4.28)years old;their gestational weeks was(39.05±1.23)weeks;there were 80 cases of gradeⅠand 39 cases of gradeⅡof American Society of Anesthesiologists(ASA).The non-hypotension group were(30.69±4.03)years old;their gestational weeks was(38.84±0.96)weeks;there were 115 cases of gradeⅠand 35 cases of gradeⅡof ASA.The clinical data were compared between the two groups.The influencing factors of hypotension in the women after anesthesia were screened using the multiple Logistic regression analysis.A risk prediction nomagram model for hypotension after anesthesia was constructed by the R software and rms package.The clinical application value of the model was validated using the calibration curves,receiver operating characteristic curves(ROC),and decision analysis curves.t andχ^(2)tests were used for the statistical analysis.Results The proportions of the women with maternal abdominal circumference>100 cm,uterine height>36 cm,and anesthesia level>T4 and the intraoperative bleeding volume in the hypotension group were higher than those in the non-hypotension group[89.08%(106/119)vs.80.00%(120/150),11.76%(14/119)vs.4.00%(6/150),20.17%(24/119)vs.8.67%(13/150),and(326.52±65.39)ml vs.(301.43±62.68)ml],with statistical differences(χ^(2)=4.070,5.813,and 7.399;t=3.199;all P<0.05).The prenatal hemoglobin level and the proportions of the women with left lateral tilt of position and prophylactic medication in the hypotension group were lower than those in the non-hypotension group[(125.95±13.46)g/L vs.(132.53±12.68)g/L,71.43%(8

关 键 词：剖宫产 麻醉 低血压 影响因素 列线图 

分 类 号：R614[医药卫生—麻醉学]