妇科恶性肿瘤全身麻醉患者围手术期意外低体温的危险因素及预测模型构建-现代医学

妇科恶性肿瘤全身麻醉患者围手术期意外低体温的危险因素及预测模型构建

单位：江苏省人民医院麻醉与围术期医学科, 江苏南京 210029

分类号：R713;R619

出版年·卷·期（页码）：2025·53·第五期（821-828）

摘要：

目的： 探讨妇科恶性肿瘤全身麻醉患者出现围手术期意外低体温(IPH)的危险因素，并建立预测模型。方法： 选取2022年6月至2023年12月我院收治的妇科恶性肿瘤全身麻醉手术患者420例，依据6∶4比例将患者分为建模集与验证集。收集患者一般人口学资料、既往病史、手术相关资料、实验室资料等，依据患者是否出现IPH分为IPH组、非IPH组。应用单因素及二元Logistic回归分析筛选妇科恶性肿瘤全身麻醉患者出现IPH的影响因素，通过R语言建立列线图预测模型，应用受试者工作特征(ROC)曲线、Hosmer-Lemeshow拟合优度检验与校准曲线评定模型区分度与校准能力，决策曲线判定模型临床有效性。结果： 在建模集，单因素分析显示，IPH组年龄≥60岁占比、手术时间、麻醉时间、术中输液量、术中腹腔冲洗量高于非IPH组，体质指数、术前血细胞比容、术前血红蛋白水平低于非IPH组(P＜0.05)。二元Logistic回归分析显示，年龄、手术时间、麻醉时间、术中输液量、术中腹腔冲洗量均为妇科恶性肿瘤全身麻醉手术患者出现IPH的危险因素，体质指数、术前血细胞比容为保护因素(P＜0.05)。建模集的ROC曲线显示，列线图预测模型预测妇科恶性肿瘤全身麻醉手术患者出现IPH的曲线下面积(AUC)为0.927(0.894～0.960)，验证集的ROC曲线显示，列线图预测模型的预测AUC为0.941(0.904～0.978)，提示模型的区分度良好。建模集与验证集的Hosmer-Lemeshow拟合优度检验、校准曲线显示模型校准能力较好。决策曲线显示，模型具有良好临床净获益。结论： 妇科恶性肿瘤全身麻醉患者出现IPH的影响因素包括年龄、体质指数、手术时间、麻醉时间、术中输液量、术中腹腔冲洗量、术前血细胞比容，且据此建立的预测模型预测性能与临床实用性良好。

Objective: To investigate the risk factors for inadvertent perioperative hypothermia(IPH) in gynecological malignancy patients under general anesthesia and establish a prediction model. Methods: A total of 420 gynecological malignancy patients who underwent surgery under general anesthesia at our hospital from June 2022 to December 2023 were selected and divided into modeling set and validation set at a ratio of 6∶4. General demographic data, past medical history, surgery-related information, laboratory findings, and other data were collected. Patients were classified into IPH group and non-IPH group based on whether IPH occurred. Univariate and binary Logistic regression analyses were used to screen for influencing factors of IPH in gynecological malignancy patients under general anesthesia. A nomogram prediction model was established using R language, and its discriminative ability and calibration were evaluated using receiver operating characteristic(ROC) curve, Hosmer-Lemeshow goodness-of-fit test, and calibration curve. Decision curve analysis was used to determine the clinical effectiveness of the model. Results: In the modeling set, univariate analysis showed that the IPH group had higher proportions of age≥60 years, longer operation time, longer anesthesia time, larger intraoperative fluid infusion volume, and larger intraoperative peritoneal lavage volume compared with the non-IPH group, while body mass index, preoperative hematocrit, and preoperative hemoglobin levels were lower(P<0.05). Binary Logistic regression analysis showed that age, operation time, anesthesia time, intraoperative fluid infusion volume, and intraoperative peritoneal lavage volume were risk factors for IPH in gynecological malignancy patients under general anesthesia, while body mass index and preoperative hematocrit were protective factors(P<0.05). The ROC curve of the modeling set showed that the area under the curve(AUC) of the nomogram prediction model was 0.927(0.894-0.960), and the ROC curve of the validation set showed that the AUC was 0.941(0.904-0.978), indicating good discriminative ability of the model. The Hosmer-Lemeshow goodness-of-fit test and calibration curve of both modeling and validation sets showed good calibration ability of the model. Decision curve analysis showed that the model had good clinical net benefit. Conclusion: The influencing factors for IPH in gynecological malignancy patients under general anesthesia included age, body mass index, operation time, anesthesia time, intraoperative fluid infusion volume, intraoperative peritoneal lavage volume, and preoperative hematocrit. Based on these factors,the prediction model was established and demonstrated good predictive performance and clinical utility.

参考文献：

[1] RIBEIRO E,FERREIRA R C,MONTANARI F L,et al. Conceptual and operational definition of the components of the nursing diagnosis hypothermia(00006) in the perioperative period[J].Rev Bras Enferm,2021,74(2)：e20190684.
[2] SIDDIQIUI T,PAL K M I,SHAUKAT F,et al. Association between perioperative hypothermia and surgical site infection after elective abdominal surgery：a prospective cohort study[J].Cureus,2020,12(10)：e11145.
[3] 崔颖,陈纬纬,杨霞,等.充气式保温毯在预防全麻高龄患者术中低体温的效果观察[J].现代医学,2020,48(8)：1069-1072.
[4] CUMIN D,FOGARIN J,MITCHELL S J,et al. Perioperative hypothermia in open and laparoscopic colorectal surgery[J].ANZ J Surg,2022,92(5)：1125-1131.
[5] WONGYINGSINN M,POOKPRAYOON V.Incidence and associated factors of perioperative hypothermia in adult patients at a university-based,tertiary care hospital in Thailand[J].BMC Anesthesiol,2023,23(1)：137.
[6] 陈颖,王莹,张越伦,等.全麻患者围手术期低体温风险预测模型的前瞻性、多中心研究[J].中国医学科学院学报,2022,44(6)：1028-1032.
[7] 刘婷婷,欧阳玲.围术期实施复合保温对卵巢恶性肿瘤患者术后康复的影响[J].中国医科大学学报,2020,49(11)：1042-1045.
[8] KOH W,CHAKRAVARTHY M,SIMON E,et al. Perioperative temperature management：a survey of 6 Asia-Pacific countries[J].BMC Anesthesiol,2021,21(1)：205.
[9] 章明阳,常后婵,梁爱群,等.广东省85所医院手术室围手术期低体温管理的现状调查[J].中华护理杂志,2020,55(7)：1039-1044.
[10] 陆菊明.《中国2型糖尿病防治指南(2020年版)》读后感[J].中华糖尿病杂志,2021,13(4)：301-304.
[11] 中国高血压防治指南修订委员会高血压联盟中国,中华医学会心血管病学分会,中国医师协会高血压专业委员会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2019,24(1):24-56.
[12] 国家麻醉专业质量控制中心.围术期患者低体温防治专家共识(2023版)[J].协和医学杂志,2023,14(4)：734-743.
[13] HABIB Z,ARIFUZAMAN M,GUPTA A,et al. Perioperative hypothermia in surgical patients：a retrospective cohort analysis at a busy district general hospital[J].Cureus,2024,16(9)：e70139.
[14] 邵小青,李北平,胡铭,等.预见性护理在妇科恶性肿瘤手术患者围术期低体温预防中的应用研究[J].实用临床护理学电子杂志,2022,7(16)：17-20.
[15] STUART C M,DYAS A R,BRONSERT M R,et al. Perioperative hypothermia in robotic-assisted thoracic surgery：Incidence,risk factors,and associations with postoperative outcomes[J].J Thorac Cardiovasc Surg,2024,167(6)：1979-1989.e1.
[16] WANG Y,YANG N,ZHANG J,et al. Construction and validation of a postoperative hypothermia prediction model in elderly patients undergoing colorectal surgery[J].Heliyon,2024,10(12)：e32391.
[17] LI L,LU Y,YANG L L,et al. Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery[J].J Clin Nurs,2023,32(13-14)：3831-3839.
[18] 吴裕华,张清华,刘建东,等.胸腔镜术后患者麻醉复苏室低体温发生的围术期影响因素分析[J].中国现代手术学杂志,2024,28(4)：328-333.
[19] SARI S,AKSOY S M,BUT A.The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors[J].Int J Clin Pract,2021,75(6)：e14103.
[20] XU R,HU X,SUN Z,et al. Incidence of postoperative hypothermia and shivering and risk factors in patients undergoing malignant tumor surgery：a retrospective study[J].BMC Anesthesiol,2023,23(1)：31.
[21] PU J,ZHAO W J,XIE X F,et al. A systematic review and meta-analysis of risk factors for unplanned intraoperative hypothermia among adult surgical patients[J].J Perianesth Nurs,2022,37(3)：333-338.
[22] 项海燕,黄立峰,钱维明,等.基于深度学习的全身麻醉患者围术期非计划低体温预测模型的构建与应用[J].中华急诊医学杂志,2022,31(8)：1116-1120.
[23] 赵丹,杨秀梅,何玉杰.子宫内膜癌患者腹腔镜术中低体温发生的影响因素分析及预测模型构建[J].中华现代护理杂志,2021,27(17)：2331-2335.
[24] HUNILER H C,DENIZ M N,GüNIŞEN, et al. Effects of perioperative hypothermia on extubation,recovery time,and postoperative shivering in breast surgery[J].Ther Hypothermia Temp Manag,2024,14(2)：110-117.
[25] CHO S A,LEE S J,YOON S,et al. Risk factors for postoperative hypothermia in patients undergoing robot-assisted gynecological surgery：a retrospective cohort study[J].Int J Med Sci,2022,19(7)：1147-1154.
[26] LU Z,CHEN X.Early prediction of intraoperative hypothermia in patients undergoing gynecological laparoscopic surgery：a retrospective cohort study[J].Medicine(Baltimore),2024,103(40)：e39038.
[27] 叶青青,陈悦,吴浩,等.老年患者全身麻醉腹腔镜下子宫切除术中低体温发生情况及危险因素[J].局解手术学杂志,2023(2)：125-128.
[28] SAGIROGLU G,OZTURK G A,BAYSAL A,et al. Inadvert-ent perioperative hypothermia and important risk factors during major abdominal surgeries[J].J Coll Physicians Surg Pak,2020,30(2)：123-128.
[29] GüVEN B,BRAHIMOLU Ö,KUŞ .Inadvertent perioperative hypothermia in ambulatory surgery patients：incidence,risk factors,and prevention initiatives[J].J Perianesth Nurs,2023,38(5)：792-798.
[30] KAUFNER L,NIGGEMANN P,BAUM T,et al. Impact of brief prewarming on anesthesia-related core-temperature drop,hemodynamics,microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer：a randomized trial[J].BMC Anesthesiol,2019,19(1)：161.
[31] ZHANG J,DENG L,WANG X,et al. Effect of forced-air warming blanket on perioperative hypothermia in elderly patients undergoing laparoscopic radical resection of colorectal cancer[J].Ther Hypothermia Temp Manag,2022,12(2)：68-73.
[32] 赵思文,王琳,刘真,等.充气温毯联合液体加温技术预防老年患者围术期低体温的效果[J].国际老年医学杂志,2023,44(2)：191-195.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录