泌尿外科达芬奇机器人手术患者术中低体温风险预测模型的构建及应用研究

Establishment and Application of a Risk Prediction Model Concerning Intraoperative Hypothermia for Patients undergoing Da Vinci Robotic Surgery in Urology Department

目的探讨泌尿外科达芬奇机器人手术患者术中低体温的影响因素,建立风险预测模型,并对应用效果进行检验。方法采用病例对照研究方法,回顾性分析2019年1月至2020年3月某院泌尿外科接受达芬奇机器人手术的患者,其中发生低体温事件的72例列为低体温组,另以1∶3配比选取同时期216例阴性病例为非低体温组,对比各项危险因子,利用Logistic回归构建预测模型,采用Hosmer-Lemeshow检验判定模型的拟合优度、受试者工作特征曲线(receiver operating characteristic curve,ROC)检测模型的预测效能。结果最终进入预测模型的因子包括:基础体温、体质量指数、室温、麻醉时间、主动保温持续时间。模型的H-L检验P=0.475,ROC曲线下面积为0.837,灵敏度为0.766,特异度为0.829,模型实际应用的总体正确率为81.3%。结论该风险预测模型效果良好,可为临床医护人员筛查机器人手术患者术中低体温高危患者并采取预防性措施提供参考。

Objective To explore the influencing factors of intraoperative hypothermia among patients undergoing Da Vinci robotic surgery in urology department,establish a risk prediction model and test its application effects.Methods The case control study method was adopted.The patients who underwent Da Vinci robotic surgery in the urology department of a hospital from January,2019 to March,2020 were retrospectively reviewed,and 72 of them with intraoperative hypothermia were defined as the hypothermia group.According to the ratio of 1:3,216 patients without intraoperative hypothermia at the same time were defined as the non-hypothermia group.Risk factors were compared to establish the prediction model using the Logistic regression analysis.The goodness of the fit and predictive validity of the model were verified by the Hosmer-Lemeshow test and the ROC curve,respectively.Results Factors in the prediction model included basic body temperature,body mass index,room temperature,anesthesia time and duration of subjective heat preservation.The P value of H-L test for the model was 0.475.The area under the ROC curve was 0.837.The sensitivity and specificity were 0.766 and 0.829,respectively.The overall accuracy of the model in the application was 81.3%.Conclusions Effects of the risk prediction model were good.It can provide reference for clinical medical staff to screen the patients at a high risk of intraoperative hypothermia in Da Vinci robotic surgery and take preventive measures.