颅脑手术患者术后低体温的危险因素分析及预测模型构建与验证

doi:10.3761/j.issn.2096-7446.2024.10.002

摘要/Abstract

摘要： 目的分析颅脑手术患者术后低体温的危险因素并构建预测模型,为临床早期筛选高危人群和干预提供参考。方法采用回顾性分析方法,选择2021年1月—2022年12月北京市某三级甲等医院的407例颅脑手术患者作为研究对象,根据时间先后按照7：3的比例分为建模组（285例）和验模组（122例）。对建模组数据依次进行单因素分析和二元Logistic回归分析,构建预测模型,并对模型进行预测效能评价;使用验模组数据对模型进行验证。结果颅脑手术患者术后低体温的发生率为40.7%,Logistic回归分析显示,术前使用咪达唑仑（OR=2.464）、手术时间<3 h（OR=3.287）、术中使用胶体液（OR=3.399）是颅脑手术患者术后低体温发生的独立危险因素,其预测模型为：Logit（P）=-2.124+0.902 × 术前使用咪达唑仑+1.190 × 手术时间<3 h+1.224 × 术中使用胶体液。建模组Hosmer-lemeshow（H-L）检验χ²=2.634,P=0.955,受试者操作特征（receiver operating characteristic,ROC）曲线下面积为0.720;验模组H-L检验χ²=13.911,P=0.084,ROC曲线下面积为0.705。结论构建的预测模型效果良好,可为医护人员筛查颅脑手术患者术后低体温的高危人群提供参考。

关键词: 低体温, 颅脑手术, 预测模型, 麻醉护理

Abstract: Objective To analyze the risk factors of postoperative hypothermia in patients undergoing craniocerebral surgery and construct a prediction model to provide reference for early clinical screening of high-risk groups and intervention. Methods By retrospective analysis method,407 patients from a tertiary Grade A hospital in Beijing from January 2021 to December 2022 were selected as the research objects,which were divided into modeling group（285 cases） and model testing group（122 cases） according to the ratio of 7：3. Univariate analysis and binary Logistic regression analysis were conducted in the modeling group and used to build the prediction model,and the prediction efficiency of the prediction model was evaluated. The data of model testing group was used to validate the model. Results The incidence of postoperative hypothermia in patients undergoing craniocerebral surgery was 40.7%. Logistic regression analysis showed that preoperative use of midazolam（OR=2.464）,operation time less than 3 hours（OR=3.287）,intraoperative use of colloidal fluid（OR=3.399） were independent risk factors for postoperative hypothermia in patients undergoing craniocerebral surgery. The prediction model was：Logit（P）=-2.124+0.902* preoperative use of midazolam +1.190* operative time less than 3 hours + 1.224* intraoperative use of colloidal fluid. The Hosmer-Lemeshow（H-L） test for the modeling group was（χ; ²=2.634,P=0.955）, the area under the ROC curve was 0.720. The H-L test for the modeling testing group was（χ; ²=13.911,P=0.084）,and the area under the ROC curve was 0.705. Conclusion The prediction model has good results and can provide reference for medical staff to screen high-risk groups with postoperative hypothermia in craniocerebral surgery patients.

Key words: Hypothermia, Craniocerebral Surgery, Prediction Model, Anesthesia Care

孙学丽, 张晓娇, 刘婷, 王冉, 李勍, 韩斌如. 颅脑手术患者术后低体温的危险因素分析及预测模型构建与验证[J]. 中华急危重症护理杂志, 2024, 5(10): 876-881.

SUN Xueli, ZHANG Xiaojiao, LIU Ting, WANG Ran, LI Qing, HAN Binru. Analysis of risk factors for postoperative hypothermia in patients undergoing craniocerebral surgery and prediction model development and validation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(10): 876-881.

参考文献

[1] 李玉梅,张宏晨,陈晓东,等. 围术期低体温风险预测模型的研究进展[J]. 护理研究,2021,35(17):3107-3110.
Li YM,Zhang HC,Chen XD,et al.Research progress on risk prediction models for perioperative hypothermia[J]. Chin Nurs Res,2021,35(17):3107-3110.
[2] Belayneh T,Gebeyehu A,Abdissa Z.Post-operative hypothermia in surgical patients at University of Gondar Hospital,Ethiopia[J]. J Anesth Clin Res,2014,5(461):2-4.
[3] 王丽敏,喻晓芬. 复杂腔镜手术患者浅表大血管保温效果观察[J]. 护理学杂志,2018,33(17):44-47.
Wang LM,Yu XF.Effectiveness of heating superficial tissues with large blood vessels in complicated laparoscopic surgeries[J]. J Nurs Sci,2018,33(17):44-47.
[4] 杨曦仑,孙雪晨,孔繁一,等. 老年全身麻醉非心脏手术后发生低体温的独立危险因素筛选及预测模型构建[J]. 中国老年学杂志,2022,42(16):3953-3955.
Yang XL,Sun XC,Kong FY,et al.Screening of independent risk factors for hypothermia after non-cardiac surgery under general anesthesia in the elderly and construction of predic-tion model[J]. Chin J Gerontol,2022,42(16):3953-3955.
[5] Karalapillai D,Story D,Hart GK,et al.Postoperative hypothermia and patient outcomes after elective cardiac surgery[J]. Anaesthesia,2011,66(9):780-784.
[6] 方丹灵,田梅梅,鲍园园,等. 加速康复外科中围术期体温控制的研究进展[J]. 护理研究,2019,33(2):310-314.
Fang DL,Tian MM,Bao YY,et al.Research progress on perioperative temperature control in enhanced recovery after surgery[J]. Chin Nurs Res,2019,33(2):310-314.
[7] 卞春,许勤,冯建萍,等. 外科手术中冲洗液温度的研究进展[J]. 护理学杂志,2022,37(20):106-109.
Bian C,Xu Q,Feng JP,et al.Research progress on temperature of irrigating fluid in surgery[J]. J Nurs Sci,2022,37(20):106-109.
[8] Schauer SG,April MD,Fisher AD,et al.Hypothermia in the combat trauma population[J]. Prehosp Emerg Care,2023,27(7):934-940.
[9] Okada Y,Matsuyama T,Morita S,et al.Machine learning-based prediction models for accidental hypothermia patients[J]. J Intensive Care,2021,9(1):6.
[10] Balki I,Khan JS,Staibano P,et al.Effect of perioperative active body surface warming systems on analgesic and clinical outcomes:a systematic review and meta-analysis of randomized controlled trials[J]. Anesth Analg,2020,131(5):1430-1443.
[11] Alfonsi P,Bekka S,Aegerter P,et al.Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices:findings of a non-randomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France[J]. PLoS One,2019,14(12):e0226038.
[12] Yi J,Lei Y,Xu S,et al.Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia:National study in China[J]. PloS one,2017,12(6):e0177221.
[13] 李丽,颜艳,房馨,等. 腹腔镜手术患者术中低体温风险预测模型的构建及验证[J]. 中华护理杂志,2022,57(4):463-468.
Li L,Yan Y,Fang X,et al.Establishment and validation of a risk prediction model for intraoperative hypothermia in patients undergoing laparoscopic surgery[J]. Chin J Nurs,2022,57(4):463-468.
[14] Sun Z,Honar H,Sessler DI,et al.Intraoperative core temperature patterns,transfusion requirement,and hospital duration in patients warmed with forced air[J]. Anesthesiology,2015,122(2):276-285.
[15] Aydın H,Şimşek T,Demiraran Y. Effects of inadvertent perioperative hypothermia on metabolic and inflammatory mediators[J]. Turk J Anaesthesiol Reanim,2019,47(6):448-455.
[16] Rauch S,Miller C,Bräuer A,et al.Perioperative hypothermia:a narrative review[J]. Int J Environ Res Public Health,2021,18(16):8749.
[17] 袁柳青. 目标导向液体治疗对脑膜瘤切除术患者全身灌注与脑代谢及术后康复的影响[D]. 广州:南方医科大学,2013.
Yuan LQ.Effects of goal-directed fluid therapy on systemic perfusion,cerebral metabolism and post-operative rehabilitation in patients undergoing meningioma resection[D]. Guangzhou:Southern Medical University,2013.
[18] 袁柳青,梁伟东,李晓玲,等. 基于每博量变异的目标导向液体治疗对脑膜瘤切除术血流动力学和S100β蛋白的影响[J]. 实用医学杂志,2020,36(22):3126-3129.
Yuan LQ,Liang WD,Li XL,et al.Goal-directed fluid therapy on hemodynamics and S100β protein in meningioma resection[J]. J Pract Med,2020,36(22):3126-3129.
[19] 普鹰,张莹,汤佳骏,等. 腹腔镜手术患者术中低体温预测模型的构建及应用[J]. 中华护理杂志,2019,54(9):1308-1312.
Pu Y,Zhang Y,Tang JJ,et al.Establishment and validation of a risk prediction model for intraoperative hypothermia in patients undergoing laparoscopic surgery[J]. Chin J Nurs,2019,54(9):1308-1312.