腹腔镜手术患者术中低体温预测模型的构建及应用

Establishment and validation of a risk prediction model for intraoperative hypothermia in patients undergoing laparoscopic surgery

目的构建腹腔镜手术患者术中低体温风险预测模型并应用于临床,验证该模型的预测效果。方法纳入2016年1月—2017年12月于上海市某三级医院行腹腔镜手术的264例患者作为建模组,将术后低体温组116例和非低体温组148例的各项危险因子进行对比,利用Logistic回归构建模型,采用Hosmer-Lemeshow判断模型的拟合优度,采用受试者操作特征曲线下面积检验模型的预测效果。于2018年1月—12月纳入132例患者作为验证组对模型进行应用研究。结果患者术中低体温发生率建模组为43.93%(116/264),验证组为41.66%(55/132);最终进入预测模型的因子分别为:基础体温(OR=0.296)、手术类型(OR=1.457)、室温(OR=0.521)和麻醉时间(OR=1.009)。H-L检验P=0.123,受试者操作特征曲线下面积为0.791,约登指数为0.867,灵敏度为0.600,特异度为0.867,实际应用的正确率为79.54%。结论本研究构建的预测模型效果良好,可为临床筛选腹腔镜手术术中低体温高危患者提供参考。

Objective To construct a predictive model to assess the risk of intraoperative hypothermia during laparoscopic surgery,and to provide technical support for screening patients with high risk of intraoperative hypothermia during laparoscopic surgery.Methods A total of 264 patients were enrolled from January 2016 to December 2017,and risk factors between hypothermia group(116 cases) and non-hypothermia group(148 cases) were compared using logistic regression for model construction. The goodness of fit of the model was verified by Hosmer-Lemeshow test. The predictive validity of the model was evaluated by the area under the ROC curve(AUC). From January to December 2018,132 patients were recruited for application of the model.Results The incidence of hypothermia in this study was 43.93%(116/264),and 41.66%(55/132). The factors that ultimately entered the predictive model were basal body temperature(OR=0.296),type of surgery(OR=1.457),room temperature(OR=0.521),and anesthesia time(OR=1.009). H-L test P=0.123,the area under the ROC curve(AUC) was 0.791,while the Youden index was 0.867,with sensitivity as 0.60 and specificity as 0.867. The accuracy of the model was 79.54%,indicating the fit and predictive validity of the model were good.Conclusion The predictive model constructed in this study can predict the risk of intraoperative hypothermia in patients undergoing laparoscopic surgery,and thus can provide a reference for clinical screening of high-risk patients.