摘要
目的分析影响腹腔镜结直肠癌手术术中低体温发生的危险因素,建立列线图预警模型,并对模型进行验证。方法回顾性选取2019年1月至2020年12月中国人民解放军总医院海南医院收治的腹腔镜结直肠癌手术275例患者为建模组,将患者按照术中是否出现低体温分为低体温组与正常体温组,采用多因素Logistic回归分析筛选影响患者术中低体温发生的危险因素,采用R软件建立列线图预警模型,并使用Hosmer-Lemeshow(HL)、校准曲线、ROC曲线下面积、临床决策曲线(DCA)评估模型预测效果。另选取2021年1—4月该医院收治的60例腹腔镜结直肠癌手术患者作为验证组对模型进行外部验证。结果275例腹腔镜结直肠癌手术患者术中低体温发生率为42.91%(118/275);本研究最终纳入麻醉时间>150 min(OR=3.939,95%CI 1.762~8.804)、术中出血量≥150 ml(OR=2.053,95%CI 1.187~3.550)、术中补液量>1500 ml(OR=2.084,95%CI 1.199~3.624)、CO_(2)总用量≥200 L(OR=2.707,95%CI 1.571~4.663)4个危险因素构建术中低体温预警模型。内部验证:ROC曲线下面积为0.797(95%CI 0.744~0.851),Logistic回归模型的HL拟合优度检验χ^(2)=6.27,P=0.617,校准曲线的预测发生风险值与实际发生风险值基本一致;外部验证:预测模型外部验证组的ROC曲线下面积为0.745(95%CI 0.662~0.628),GiViTI校准曲线带的95%CI区域均未穿过45°对角平分线(P=0.735),DCA阈值为0.01~0.97时列线图模型预测术中低体温是合理的,患者净获益高。结论基于腹腔镜结直肠癌术中低体温发生风险的危险因素建立的列线图预警模型具有良好的区分度、一致性与临床实用性,可为医护人员预测术中低体温的发生提供一定参考价值。
Objective To analyze the risk factors that affect the occurrence of hypothermia during laparoscopic colorectal cancer surgery,and establish a nomogram warning model,and verify the model.Methods The clinical data of 275 patients undergoing laparoscopic colorectal cancer surgery in Hainan Branch of Chinese People′s Liberation Army General Hospital from January 2019 to December 2020 were retrospectively selected as the modeling group.The patients were divided into hypothermia group and normal group according to whether hypothermia occurred during the operation,and multivariate Logistic regression analysis was used to screen the risk factors that affect the occurrence of hypothermia during the operation.To use R software to establish a nomogram early warning model,and use Hosmer-Lemeshow(HL),calibration curve,area under the ROC curve and clinical decision curve(DCA)to evaluate the prediction effect of the model.In addition,60 patients undergoing laparoscopic colorectal cancer surgery in the hospital from January to April 2021 were selected as the verification group for external verification of the model.Results The incidence of intraoperative hypothermia in 275 patients undergoing laparoscopic colorectal cancer surgery was 42.91%(118/275).In this study,4 risk factors including anesthesia time>150 min(OR=3.939,95%CI 1.762-8.804),intraoperative blood loss≥150 ml(OR=2.053,95%CI 1.187-3.550),intraoperative fluid supplement≥1500 ml(OR=2.084,95%CI 1.199-3.624),and total CO_(2) dosage≥200 L(OR=2.707,95%CI 1.571-4.663)were included to construct an intraoperative hypothermia warning model.Internal verification:the area under the ROC curve was 0.797(95%CI 0.744-0.851),the HL goodness of fit test of the Logistic regression model withχ^(2)=6.27,P=0.617,the predicted occurrence risk value of the calibration curve was basically the same as the actual occurrence risk value.External validation:the area under the ROC curve of the external validation group of the prediction model was 0.745(95%CI 0.662-0.628).The 95%CI area of the GiViTI calibration curve did not cross the 45°diagonal bisector(P=0.735),and when the DCA threshold range was 0.01-0.97,the nomogram model was reasonable to predict intraoperative hypothermia and the patient could get high net benefit.Conclusions The nomogram warning model established based on the risk factors of hypothermia during laparoscopic colorectal cancer surgery has good discrimination,consistency and clinical practicability,and can provide a certain reference value for intraoperative medical staff to predict the occurrence of hypothermia.
作者
刘琳
邓溧
冯龙
Liu Lin;Deng Li;Feng Long(Anesthesia Surgery Center,Hainan Branch of Chinese People′s Liberation Army General Hospital,Sanya 572013,China;Operating Room,Hainan Branch of Chinese People′s Liberation Army General Hospital,Sanya 572013,China;Department of Anesthesiology,Hainan Branch of Chinese People′s Liberation Army General Hospital,Sanya 572013,China)
出处
《中国实用护理杂志》
2022年第20期1546-1553,共8页
Chinese Journal of Practical Nursing
关键词
腹腔镜手术
影响因素
结直肠肿瘤
术中低体温
列线图模型
Laparoscopic surgery
Influencing factor
Colorectal cancer
Surgical hypothermia
Nomograms
