非体外循环冠状动脉旁路移植术患者非计划性术中低体温风险预测模型的构建  

Construction of a risk prediction model for unplanned intraoperative hypothermia in patients undergoing off-pump coronary artery bypass grafting

作　　者：冯敏 马文涓 加依娜尔·木哈台勒 胡媛 李茹 徐月曙 李丽[3] Feng Min;Ma Wenjuan;Jiayinaer Muhataile;Hu Yuan;LI Ru;Xu Yueshu;Li Li(College of Nursing Xinjiang Medical University,Operating Room of the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumqi 830000,China)

机构地区：[1]新疆医科大学护理学院,乌鲁木齐830000 [2]新疆医科大学第一附属医院手术室 [3]新疆医科大学新疆区域人群疾病与健康照护研究中心

出　　处：《中国体外循环杂志》2025年第1期11-16,共6页Chinese Journal of Extracorporeal Circulation

基　　金：新疆维吾尔自治区卫生与健康适宜技术推广项目(SYTG-Y202321)。

摘　　要：目的分析非体外循环冠状动脉旁路移植术(OPCAB)患者非计划性术中低体温(IIH)危险因素,构建并验证预测模型。方法选取2023年1月至2024年1月在新疆医科大学第一附属医院接受OPCAB 157例手术患者的临床资料,根据术中是否发生低体温分为低体温组(n=82)和非低体温组(n=75),采用单因素、套索回归筛选预测因子,通过逻辑回归建立风险预测模型,并绘制列线图。分别采用受试者工作特征曲线-曲线下面积(ROC-AUC)、Hosmer-Lemeshow(H-L)拟合优度检验、临床决策曲线(DCA),评价模型的区分度、校准度、临床有用性,内部验证采用Bootstrap法。结果OPCAB患者IIH发生率为52.23%。术前体温≥36.35℃、体重指数≥25.93 kg/m^(2)、术中输液量≥2025 ml、术中出血量>300 ml 4个因素被纳入模型。该模型ROC-AUC为0.821(95%CI:0.756~0.886),H-L拟合优度检验表现出良好的一致性,DCA显示模型临床有用性较好,内部验证ROC-AUC为0.801(95%CI:0.731~0.871),Brier分数分别为0.151,0.212。结论OPCAB患者IIH发生率较高,本研究建立的列线图模型效果良好,可为医护人员早期评估及预防提供参考。Objective To analysis of the risk factors for intraoperative inadvertent hypothermia(IIH)in patients undergoing off-pump coronary artery bypass(OPCAB),and develop and validate a predictive model.Methods The clinical data of 157 OPCAB patients from January 2023 to January 2024 were analyzed.Patients were divided into the hypothermia group(n=82)and the non-hypothermia group(n=75)based on intraoperative temperature.Univariate analysis and LASSO regression were used to screen predictive factors,and a risk prediction model was developed using logistic regression,followed by nomogram construction.The model’s discrimination,calibration,and clinical utility were evaluated using the area under the receiver operating characteristic curve(ROC-AUC),Hosmer-Lemeshow(H-L)goodness-of-fit test,and decision curve analysis(DCA),respectively.Internal validation was performed using the bootstrap method.Results The incidence of IIH in OPCAB patients was 52.23%.Four factors-admission temperature≥36.35℃,BMI≥25.93(kg/m^(2)),intraoperative fluid infusion≥2025 ml,and intraoperative blood loss>300 ml-were included in the model.The model achieved an ROC-AUC of 0.821(95%CI:0.756-0.886),with good calibration shown by the H-L test,and DCA indicated favorable clinical utility.Internal validation an ROC-AUC of 0.801(95%CI:0.731-0.871)and Brier scores of 0.151 and 0.212 for the development and validation datasets,respectively.Conclusion The incidence of IIH in OPCAB patients is high.The nomogram model established in this study demonstrates good predictive performance and can serve as a reference for early assessment and prevention by medical staff.

关 键 词：非体外循环冠状动脉旁路移植术 术中低体温 列线图 危险因素 预测模型 

分 类 号：R65[医药卫生—外科学]