剖宫产术中寒战风险预测模型及列线图的构建  

Construction of risk prediction model and nomogram of shivering during cesarean section

作　　者：胡欣[1] 夏园园 林优优[1] HU Xin;XIA Yuanyuan;LIN Youyou(Operating Room,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院手术室,浙江温州325000

出　　处：《中国现代医生》2025年第10期6-10,15,共6页China Modern Doctor

基　　金：浙江省市县级科技计划项目(Y2023609)。

摘　　要：目的构建剖宫产术中产妇寒战风险预测模型并验证模型的预测效果。方法选取2023年1月至4月于温州医科大学附属第二医院行剖宫产手术的225例产妇为研究对象,根据术中是否发生寒战,将其分为寒战组(101例)和非寒战组(124例)。采用多因素Logistic回归分析影响因素并构建列线图预测模型。结果寒战组产妇的产次、术中有保温措施占比均显著少于非寒战组,糖尿病占比、球蛋白、状态焦虑量表(state anxiety inventory,S-AI)评分、特质焦虑量表评分均显著高于非寒战组,麻醉后体温下降幅度显著大于非寒战组(P<0.05)。多因素Logistic回归分析结果显示,糖尿病病史、S-AI评分、麻醉方式、麻醉后体温下降幅度、术中有保温措施均是剖宫产术中产妇寒战的影响因素(P<0.05)。构建的预测模型预测剖宫产术中产妇寒战的曲线下面积(area under the curve,AUC)为0.831,十折内部交叉验证得出的最大AUC为0.934,提示模型具有较好的拟合效果及鉴别效度。结论该模型能较好地预测剖宫产术中产妇寒战的发生风险,为医护人员及时对高危产妇采取预防性管理措施提供参考。Objective The risk prediction model of shivering during cesarean section was constructed and its prediction effect was verified.Methods A total of 225 parturient women who underwent cesarean section in the Second Affiliated Hospital of Wenzhou Medical University from January to April 2023 were selected as study objects.According to whether shivering occurred during the operation,they were divided into shivering group(101 cases)and non-shivering group(124 cases).Multivariate Logistic regression was used to analyze the influencing factors and build a nomogram prediction model.Results The parity and proportion of intraoperative warming measures in shivering group were significantly lower than those in non-shivering group,and the proportion of diabetes,globulin,state anxiety inventory(S-AI)score and trait anxiety inventory score were significantly higher than those in non-shivering group,and post-anesthesia body temperature decrease was significantly greater than that in non-shivering group(P<0.05).Multivariate Logistic regression analysis revealed that diabetes history,S-AI score,anesthesia method,post-anesthesia body temperature decrease,and intraoperative warming measures were all influencing factors of shivering during cesarean section(P<0.05).The area under the curve(AUC)of the constructed prediction model for predicting shivering during cesarean section was 0.831,and the maximum AUC obtained by ten-fold internal cross-validation was 0.934,suggesting that the model had good fitting effect and differential validity.Conclusion The model can predict the risk of parturient shivering during cesarean section,and provide reference for medical personnel to take preventive management measures for high-risk puerperal shivering in time.

关 键 词：剖宫产 寒战 预测模型 状态焦虑量表评分 

分 类 号：R719.82[医药卫生—妇产科学] R441.3[医药卫生—临床医学]