颅脑手术患者全麻苏醒期发生低氧血症护理预警模型的建立与验证

Establishment and verification of an individualized nursing early warning model for predicting hypoxemia during general anesthesia during craniocerebral surgery

目的构建个体化预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,并对模型的预测效能予以验证。方法分别选取2019年10月-2020年6月和2020年7月-2020年9月于我院行全麻下颅脑外科手术的患者作为训练集(n=119)和验证集(n=38),收集患者的临床资料,使用单因素和Logistic回归多因素分析训练集患者全麻苏醒期发生低氧血症的影响因素,并建立相关列线图模型。结果观察者的警觉性/镇静评估量表(OAA/S)评分BMI≥24、吸烟、高血压、气道不通畅、OAA/S评分≥3分和Riker躁动评分≥5分是颅脑手术全麻苏醒期发生低氧血症的危险因素(P<0.05)。依此建立预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,模型验证结果显示训练集和验证集的C-index分别为0.861和0.796,校正曲线均趋近于理想曲线,ROC曲线的AUC分别为0.875(95%CI 0.833~0.892)和0.826(95%CI 0.787~0.873),表明该模型具有良好的预测能力。结论颅脑手术全麻苏醒期发生低氧血症危险因素较多,基于风险因素构建的列线图护理模型能有效预警全麻苏醒期发生低氧血症的风险概率,对颅脑手术患者的临床护理具有一定的指导意义。

Objective To construct an individualized nursing warning model for predicting the occurrence of hypoxemia during general anesthesia during craniocerebral surgery,and to verify the predictive efficacy of the model.Methods Patients who underwent craniocerebral surgery under general anesthesia in our hospital from October 2019 to June 2020 and from July 2020 to September 2020 were selected as the training set(n=119)and verification set(n=38).The clinical data of patients were collected,the influencing factors of hypoxemia during the recovery period of general anesthesia were analyzed by univariate and logistic regression,and the related nomogram model was established.Results The observer's assessment of alertness/sedation scale BMI≥24 kg/m 2,smoking,hypertension,airway obstruction,OAA/S score≥3 and Riker agitation score≥5 were risk factors for hypoxemia during the recovery from general anesthesia during craniocerebral surgery(P<0.05).Based on this,a nursing warning model for predicting hypoxemia during general anesthesia during craniocerebral surgery was established.The model verification results showed that the C-index of the training set and the validation set were 0.861 and 0.796,and the calibration curve was close to the ideal curve,ROC The AUC of the curve is 0.875(95%CI 0.833~0.892)and 0.826(95%CI 0.787~0.873),respectively,indicating that the model has good predictive ability.Conclusion There are many risk factors for hypoxemia during the period of general anesthesia during craniocerebral surgery.The nomogram nursing model based on risk factors can effectively warn the risk of hypoxemia during the period of general anesthesia.Clinical nursing has certain guiding significance.