经尿道钬激光前列腺剜除术后低体温的危险因素及列线图预测模型的构建  

Risk factors for hypothermia after transurethral holmium laser enucleation of the prostate and development of a nomogram model

作　　者：姜君 封硕 孙银贵 安燕 JIANG Jun;FENG Shuo;SUN Yingui;AN Yan(Operating Room,Affiliated Hospital of Shandong Second Medical University,Weifang Shandong 261000;Department of Gynecology,Affiliated Hospital of Shandong Second Medical University,Weifang Shandong 261000;Department of Anesthesiology,Affiliated Hospital of Shandong Second Medical University,Weifang Shandong 261000,China)

机构地区：[1]山东第二医科大学附属医院手术室,山东潍坊261000 [2]山东第二医科大学附属医院妇科,山东潍坊261000 [3]山东第二医科大学附属医院麻醉科,山东潍坊261000

出　　处：《中南大学学报(医学版)》2024年第11期1741-1750,共10页Journal of Central South University :Medical Science

基　　金：潍坊市科学技术发展计划(医学类)(2023YX057);潍坊市卫生健康委员会科研项目(WFWSJK-2023-033)。

摘　　要：目的:术后低体温是临床常见并发症,其发生率较高且可能对患者术后恢复产生不利影响。经尿道钬激光前列腺剜除术(transurethral holmium laser enucleation of prostate,HoLEP)是一种用于治疗良性前列腺增生的微创手术,具有出血少、适应证广、术后恢复快等优点,然而有关HoLEP术后患者低体温风险因素的研究相对较少,尤其缺乏预测模型来指导临床实践。本研究旨在通过建立一个预测模型来预测患者在HoLEP术后发生低体温的风险,并探讨相关风险因素。方法:回顾性收集在山东第二医科大学附属医院接受HoLEP治疗的患者,根据是否发生低体温分为低体温组和非低体温组,并对2组的术前、术中及术后指标进行比较。采用最小绝对收缩和选择算法(leastabsolute shrinkage and selection operator,LASSO)回归结合逻辑回归方法对临床数据进行分析。构建预测HoLEP后低体温风险的预测模型,并用Bootstrap检验进行了内部验证。结果:403例患者纳入分析,其中85例患者发生术后低体温,发生率为21.1%。Logistic回归分析确定手术时长(OR=1.009,95%CI 1.003~1.015)、偏瘦(OR=9.881,95%CI4.038~24.910)、前列腺重量(OR=1.021,95%CI 1.012~1.030)为术后低体温的独立风险因素,并纳入列线图模型。经内部验证,该列线图模型显示出较强的区分度,受试者操作特征曲线下面积(area under the curve,AUC)为0.755(95%CI0.686~0.820),C指数(C-index)为0.832(95%CI 0.787~0.865)。校准曲线显示良好的一致性。决策曲线分析显示当术后低体温发生风险阈值在8%97%范围内时,该列线图更具临床价值。结论:本研究开发了一个可以预测HoLEP后患者发生低体温风险的列线图,为临床医师提供一个简单的预测工具。Objective:Postoperative hypothermia is a common clinical complication with a high incidence rate,potentially adversely affecting postoperative recovery.Transurethral holmium laser enucleation of the prostate(HoLEP)is a minimally invasive procedure for benign prostatic hyperplasia(BPH).Offering advantages such as minimal bleeding,broad indications,and rapid postoperative recovery.However,research on risk factors for postoperative hypothermia following HoLEP remains limited,and predictive models for guiding clinical practice are lacking.This study aims to develop a predictive model for assessing the risk of postoperative hypothermia in HoLEP patients and to identify relevant risk factors.Methods:Clinical data from patients who underwent HoLEP at affiliated Hospital of Shandong Second Medical University were retrospectively collected.Patients were categorized into a hypothermia group and a non-hypothermia group based on whether postoperative hypothermia occurred.Preoperative,intraoperative,and postoperative indicators were compared between the 2 groups.Least absolute shrinkage and selection operator(LASSO)regression combined with logistic regression analysis was used to analyze clinical data.A predictive model for assessing the risk of postoperative hypothermia after HoLEP was constructed and internally validated using bootstrap resampling.Results:A total of 403 patients were included in the analysis,among whom 85 patients developed postoperative hypothermia,with an incidence rate of 21.1%.Logistic regression analysis identified operative duration(OR=1.009,95%CI 1.003 to 1.015),underweight status(OR=9.881,95%CI 4.038 to 24.910),and prostate weight(OR=1.021,95%CI 1.012 to 1.030)as independent risk factors for postoperative hypothermia,and these variables were incorporated into the nomogram model.Internal validation showed strong discriminative ability of the nomogram,with an area under the receiver operating characteristic curve(AUC)of 0.755(95%CI 0.686 to 0.820)and a C-index of 0.832(95%CI 0.787 to 0.865).The calibr

关 键 词：低体温 前列腺剜除 风险因素 列线图 预测模型 

分 类 号：R699.8[医药卫生—泌尿科学]