子宫切除术患者术中高血糖影响因素分析及预测模型构建-现代医学

子宫切除术患者术中高血糖影响因素分析及预测模型构建

单位：1. 中国人民解放军海军第九七一医院妇产科, 山东青岛 266071;
2. 青岛大学附属医院(平度) 产科, 山东青岛 266700

分类号：R713.4

出版年·卷·期（页码）：2025·53·第十期（1612-1618）

摘要：

目的：探究子宫切除术患者术中高血糖的影响因素，并构建预测模型。方法：前瞻性选取2021年2月至2024年10月接受子宫切除术的220例患者为研究对象，依据术中是否发生高血糖分为高血糖组与正常血糖组。收集并比较两组一般人口学资料、疾病史、实验室指标及围手术期指标等，采用Logistic多因素回归模型探讨子宫切除术患者术中高血糖的独立影响因素，建立列线图预测模型，探讨模型区分度、拟合度、校准度及内部验证一致性。结果：220例子宫切除术患者术中高血糖发生率为20.91%。应用逐步后退法筛选变量，多因素Logistic回归分析显示，麻醉时长≥3 h(OR=2.787，95%CI 1.305～5.950)、术前C反应蛋白/白蛋白≥0.17(OR=2.409，95%CI 1.119～5.186)、术前动脉血糖高(OR=12.308，95%CI 4.296～35.264)均为子宫切除术患者术中高血糖发生的独立危险因素(P＜0.05)。绘制受试者工作特征(ROC)曲线显示，该模型对子宫切除术患者术中高血糖的预测曲线下面积(AUC)为0.786(95%CI 0.715～0.856)，预测灵敏度为80.43%，特异度为64.94%。绘制校准曲线显示，模型平均绝对误差为0.016，霍斯默-莱梅肖检验(H-L)显示，模型不存在过度拟合现象(χ²=6.543，P=0.587)。自助法(Bootstrap)内部验证发现，C指数为0.789，验证结果一致性较高。结论：子宫切除术患者术中高血糖发生率较高，麻醉时长、术前CRP/ALB、术前动脉血糖均是其影响因素，临床可据此采取预防措施。

Objective: To explore the influencing factors of intraoperative hyperglycemia in patients undergoing hysterectomy and construct a prediction model. Methods: A prospective study was conducted on 220 patients who underwent hysterectomy from February 2021 to October 2024. According to whether intraoperative hyperglycemia occurred, patients were divided into hyperglycemia group and normal glucose group. General demographic data, disease history, laboratory indicators, and perioperative indicators were collected and compared between the two groups. Multivariate Logistic regression model was used to explore the independent influencing factors of intraoperative hyperglycemia in patients undergoing hysterectomy. A nomogram prediction model was established to explore the model's discrimination, goodness of fit, calibration, and internal validation consistency. Results: The incidence of intraoperative hyperglycemia was 20.91% among 220 patients undergoing hysterectomy. Using stepwise backward elimination to screen variables, multivariate Logistic regression analysis showed that anesthesia duration ≥3 h(OR=2.787, 95%CI 1.305-5.950), preoperative C-reactive protein/albumin ≥0.17(OR=2.409, 95%CI 1.119-5.186), and high preoperative arterial blood glucose(OR=12.308, 95%CI 4.296-35.264) were all independent risk factors for intraoperative hyperglycemia in patients undergoing hysterectomy(P<0.05). The receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) of this model for predicting intraoperative hyperglycemia in patients undergoing hysterectomy was 0.786(95%CI 0.715-0.856), predictive sensitivity of 80.43%, and specificity of 64.94%. The calibration curve showed that the model had a mean absolute error of 0.016. The Hosmer-Lemeshow test(H-L) showed no overfitting in the model(χ²=6.543, P=0.587). Bootstrap internal validation revealed a C-index of 0.789, demonstrating high consistency in validation results. Conclusion: The incidence of intraoperative hyperglycemia in patients undergoing hysterectomy is relatively high. Anesthesia duration, preoperative CRP/ALB, and preoperative arterial blood glucose are all influencing factors. Clinical preventive measures can be taken accordingly.

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