胸科手术患者麻醉苏醒时间Nomogram预测分析

A prognostic Nomogram for recovery time of general anesthesia after thoracic surgery

目的构建预测患者麻醉苏醒时间的Nomogram,并评估其预测价值。方法选取2018年10-11月收治的341例胸科手术患者为A组,利用单因素回归分析筛选影响患者麻醉苏醒时间的相关因素,并通过多因素cox比例风险回归模型分析影响患者麻醉苏醒时间的独立危险因素。构建预测麻醉苏醒时间的Nomogram,利用一致性指数、受试者工作特征曲线和校准图评价预测模型的准确性。另收集2018年12月收治的178例胸科手术患者为B组,对预测模型进行外部验证。结果患者的性别、年龄、体质量、手术日期、手术类型、手术时间、麻醉医师职称、芬太尼用量、瑞芬太尼泵、诱导时咪达唑仑用量、右美托咪定泵及手术结束时新斯的明用量是麻醉苏醒时间的影响因素(P<0.1)。患者的性别、年龄、体质量、手术时间以及咪达唑仑用量是影响患者麻醉苏醒时间的独立危险因素(P<0.05)。胸科手术患者麻醉苏醒时间Nomogram中,男性术后30 min内苏醒的可能性较女性低;年龄越大、体质量越轻、咪达唑仑用量越大者,术后30 min内苏醒的可能性越低。手术时间为2~6 h的患者,手术时间越长越不容易苏醒,但对于手术时间≤2 h和手术时间超过6 h的患者,麻醉苏醒时间较短。A组一致性指数为0.658(标准误=0.019),B组一致性指数为0.694(标准误=0.025)。A组受试者工作特征曲线下面积为0.740,B组受试者工作特征曲线下面积为0.725,说明模型的预测能力较好。结论本研究构建的Nomogram可以很好的预测患者在术后30 min内苏醒情况,为临床麻醉工作提供参考。

Objective To predict the recovery time for patients from general anesthesia after thoracic surgery by nomogram.Methods A total of 341 patients admitted to thoracic surgery from October to November 2018 were selected as Group A.Univariate regression analysis was used to screen out the relevant factors affecting the anesthesia recovery time of patients,and multivariate cox proportional risk regression model was used to analyze the independent risk factors influencing the anesthesia recovery time of patients.Build forecasting anesthesia to the Nomogram of time,using the consistency index,and calibration the receiver-operating characteristic curve diagram evaluation of the accuracy of the prediction model.In addition,178 cases of thoracic surgery patients admitted in December 2018 were collected as Group B for external validation of the prediction model.Results Patients′ gender,age,body mass,date of surgery,type of surgery,operation time,anesthesiologist′s title,fentanyl dosage,remifentanil pump,midazolam dosage at induction,dexmedetomidine pump and neostigmine dosage at the end of surgery were the influencing factors of anesthesia wake time(P<0.1).Gender,age,body mass,operation time and the dosage of midazolam were independent risk factors affecting the recovery time of patients under anesthesia(P<0.05).Nomogram awakening time of patients with thoracic surgery anesthesia,the possibility of male awaken within 30 minutes was lower than female.The older the patient was,the lighter the body weight was,and the higher the dosage of midazolam was,the lower the possibility of recovery within 30 minutes after surgery.The longer the operation time was,the less likely patients were to wake up.However,for patients whose operation time was less than 2 hours and whose operation time was more than 6 hours,the anesthesia waking time was shorter.The consistency index of Group A was 0.658(standard error=0.019)and that of Group B was 0.694(standard error=0.025).The area under the operating characteristic curve of subjects in Group A was 0.740,and that under the operating characteristic curve of subjects in Group B was 0.725,indicating that the model had A good prediction ability.Conclusion A nomogram integrating five variables was developed to assist in individual prognostic prediction of recovery in 30 minutes from general anesthesia after surgery.