大面积烧伤患者术中发生低体温的危险因素及风险预测模型构建  

Risk factors and risk prediction model construction for intraoperative hypothermia in patients with extensive burns

作　　者：樊敏 袁亚翠 郑婉君 王曼 董毓敏 黄容 韩琳 田静 苏敏 Fan Min;Yuan Yacui;Zheng Wanjun;Wang Man;Dong Yumin;Huang Rong;Han Lin;Tian Jing;Su Min(Department of Burn and Plastic Surgery,The Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院烧伤整形科,西安710038

出　　处：《保健医学研究与实践》2024年第11期86-90,98,共6页Health Medicine Research and Practice

基　　金：陕西省重点研发计划项目(2021SF-292)。

摘　　要：目的探讨影响大面积烧伤患者术中发生低体温的影响因素,并建立风险预测模型。方法选取2020年1月—2024年3月空军军医大学第二附属医院收治的138例行植皮手术的大面积烧伤患者为研究对象,根据患者术中是否发生低体温分为非低体温组(n=60)和低体温组(n=78)。收集患者临床资料,采用多元logistic逐步回归分析患者术中发生低体温的影响因素,建立风险预测模型并绘制列线图,同时绘制受试者工作特征(ROC)曲线、校准曲线检验模型的预测效果。结果多元logistic逐步回归分析结果显示,手术时间、麻醉时间、术中输液量、术中冲洗液用量是大面积烧伤患者术中发生低体温的独立影响因素(P<0.05)。基于上述影响因素得到大面积烧伤患者术中发生低体温的风险预测模型:P=1/[1+e^(-1.359+0.003×(手术时间)+0.004×(麻醉时间)+0.025×(术中输液量)+0.002×(术中冲洗液用量))],Hosmer-Lemeshow检验拟合模型校准度χ^(2)=2.025,P=0.155。预测模型外部验证的ROC的曲线下面积(AUC)为0.797(95%CI:0.693~0.852),灵敏度为80.00%,特异度为66.67%。结论手术时间、麻醉时间、术中输液量、术中冲洗液用量是大面积烧伤患者术中发生低体温的独立影响因素,据此构建的低体温风险预测模型可较好地预测术中低体温发生风险。Objective To explore the risk factors influencing intraoperative hypothermia in patients with extensive burns and to construct a risk prediction model.Methods A total of 138 patients with extensive burns who underwent skin grafting surgery at the Second Affiliated Hospital of Air Force Medical University from January 2020 to March 2024 were selected as the study participants.Based on the presence or absence of intraoperative hypothermia,the patients were assigned to a non-hypothermia group(n=60)and a hypothermia group(n=78).Clinical data were collected,and multivariate logistic stepwise regression analysis was used to identify the influence factors for intraoperative hypothermia.A risk prediction model was established,and a nomogram was constructed.The predictive performance of the model was evaluated using ROC curves and calibration curves.Results Multivariate logistic stepwise regression analysis showed that surgical duration,anesthesia duration,intraoperative fluid infusion volume,and intraoperative irrigation volume were independent influence factors for intraoperative hypothermia in patients with extensive burns(P<0.05).Based on these influence factors,the risk prediction model for intraoperative hypothermia in patients with extensive burns was established as follows:P=1/[1+e-1.359+0.003×^((surgical duration)+0.004×(anesthesia duration)+0.025×(intraoperative fluid infusion volume)+0.002×(intraoperative irrigation volume))].The Hosmer-Lemeshow test indicated a model calibration atχ^(2)=2.025(P=0.155).The AUC of the ROC curve for external validation of the prediction model was 0.797(95%CI:0.693-0.852),with a sensitivity of 80.00%and a specificity of 66.67%.Conclusion Surgical duration,anesthesia duration,intraoperative fluid infusion volume,and intraoperative irrigation volume are independent influence factors for intraoperative hypothermia in patients with extensive burns.The constructed risk prediction model for hypothermia can effectively predict the risk of intraoperative hypothermia.

关 键 词：大面积烧伤 植皮手术 低体温 危险因素 风险预测模型 

分 类 号：R644[医药卫生—外科学]