2型糖尿病患者胃癌术后麻醉苏醒时间的影响因素分析及列线图模型的构建

Analysis of influencing factors for anesthesia recovery time after gastric cancer surgery in patients with type 2 diabetes mellitus and establishment of a nomogram model

目的分析2型糖尿病患者胃癌术后麻醉苏醒时间的影响因素并构建列线图模型。方法回顾性分析邯郸市中心医院2020年2月至2021年1月120例行胃癌开腹手术治疗的2型糖尿病患者的临床资料。其中,麻醉苏醒时间>30 min 50例(观察组),麻醉苏醒时间≤30 min 70例(对照组)。采用多因素Logistic回归分析影响2型糖尿病患者胃癌术后麻醉苏醒时间的独立危险因素。绘制受试者工作特征(ROC)曲线,分析各影响因素预测2型糖尿病患者胃癌术后麻醉苏醒时间的最佳截断值等。采用R语言软件4.0"rms"包构建预测影响2型糖尿病患者胃癌术后麻醉苏醒时间的列线图模型。结果观察组男性比例、年龄、术后体温下降幅度、手术时间和术中输血率明显大于对照组[84.00%(42/50)比20.00%(14/70)、(60.31±14.23)岁比(47.58±8.96)岁、(0.33±0.09)℃比(0.28±0.08)℃、(92.32±8.58)min比(84.54±6.24)min和38.00%(19/50)比10.00%(7/70)],体质量指数(BMI)、心率和手术室温度明显小于对照组[(20.11±3.96)kg/m^(2)比(24.69±4.58)kg/m^(2)、(103.73±9.57)次/min比(118.32±18.15)次/min和(28.66±1.58)℃比(30.25±1.98)℃],差异有统计学意义(P<0.01);两组吸烟、饮酒、高血压、高血脂、冠心病、麻醉药种类、麻醉师职称、肌肉松弛药种类和体温比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,年龄、BMI、心率、术后体温下降幅度、手术室温度和手术时间预测2型糖尿病患者胃癌术后麻醉苏醒时间的最佳截断值分别为46岁、21.8 kg/m^(2)、113次/min、0.3℃、30.6℃和91 min。多因素Logistic回归分析结果显示,性别(男性)、年龄(>46岁)、BMI(≤21.8 kg/m^(2))、术后体温下降幅度(>0.3℃)、手术室温度(≤30.6℃)和手术时间(>91 min)是影响2型糖尿病患者胃癌术后麻醉苏醒时间的独立危险因素(OR=1.909、1.815、1.606、1.458、1.521和1.539,95%CI 1.215~3.000、1.014~3.249、1.252~1.941、1.251~1.628、1.068~2.167和1.119~1.828,P<0.01或<0.05)。将性别、年龄、BMI、术后体温下降幅度、手术室温度、手术时间作为构建列线图模型的预测因子,内部验证结果显示,列线图模型预测2型糖尿病患者胃癌术后麻醉苏醒时间的C-index为0.701(95%CI 0.672~0.724);校准曲线显示,观测值与预测值之间保持较好一致性;列线图模型预测2型糖尿病患者胃癌术后麻醉苏醒时间的阈值>0.20,列线图模型提供临床净收益;列线图模型临床净收益均高于性别、年龄、BMI、术后体温下降幅度、手术室温度和手术时间。结论基于性别、年龄、BMI、术后体温下降幅度、手术室温度和手术时间构建了预测2型糖尿病患者胃癌术后麻醉苏醒时间的列线图模型,该模型对2型糖尿病患者胃癌术后麻醉苏醒时间的预测具有重要意义。

Objective To analyze the influencing factors of anesthesia recovery time after gastric cancer surgery in patients with type 2 diabetes mellitus(T2DM),and establish a nomogram model.Methods The clinical data of 120 T2DM patients underwent open surgery for gastric cancer from February 2020 to January 2021 in Handan Central Hospital were retrospectively analyzed.Among them,50 patients had an anesthesia recovery time>30 min(observation group),and 70 patients had an anesthesia recovery time≤30 min(control group).Multivariate Logistic regression was used to analyze the independent risk factors of anesthesia recovery time after gastric cancer surgery in patients with T2DM.Receiver operating characteristic(ROC)curve was drawn to analyze the optimal cut-off value of each influencing factor for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM.A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM was established with R language software 4.0"rms"package.Results The proportion of men,age,decrease amplitude of postoperative temperature,operation time intraoperative blood transfusion rate in observation group were significantly higher than those in control group:84.00%(42/50)vs.20.00%(14/70),(60.31±14.23)years vs.(47.58±8.96)years,(0.33±0.09)℃vs.(0.28±0.08)℃,(92.32±8.58)min vs.(84.54±6.24)min and 38.00%(19/50)vs.10.00%(7/70),the body mass index(BMI),heart rate and operating room temperature were significantly lower than those in control group:(20.11±3.96)kg/m^(2) vs.(24.69±4.58)kg/m^(2),(103.73±9.57)beats/min vs.(118.32±18.15)beats/min and(28.66±1.58)℃vs.(30.25±1.98)℃,and there were statistical differences(P<0.01);there were no statistical differences in smoking,drinking,hypertension,hyperlipidemia,coronary heart disease,anesthetic drug types,anesthesiologist job title,muscle relaxant drug types and body temperature between 2 groups(P>0.05).ROC curve analysis results showed that the optimal cut-off values of age,BMI,heart rate,decrease amplitude of postoperative temperature,operating room temperature and operation time for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM were 46 years old,21.8 kg/m^(2),113 beats/min,0.3℃,30.6℃and 91 min,respectively.Multivariate Logistic regression analysis results showed that gender(male),age(>46 years old),BMI(≤21.8 kg/m^(2)),decrease amplitude of postoperative temperature(>0.3℃),operating room temperature(≤30.6℃)and operation time(>91 min)were independent risk factors for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM(OR=1.909,1.815,1.606,1.458,1.521 and 1.539;95%CI 1.215 to 3.000,1.014 to 3.249,1.252 to 1.941,1.251 to 1.628,1.068 to 2.167 and 1.119 to 1.828;P<0.01 or<0.05).When gender,age,BMI,decrease amplitude of postoperative temperature,operating room temperature and operation time were included as predictors for constructing the nomogram model,the internal validation results showed that the c-index of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was 0.701(95%CI 0.672 to 0.724);calibration curve showed good agreement between observed value and predicted value;the threshold value of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was>0.20,and the nomogram model provided a net clinical benefit;the clinical net benefit of the nomogram model was greater than that of sex,age,BMI,decrease amplitude of postoperative temperature,operating room temperature and operation time.Conclusions A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM is constructed based on gender,age,BMI,decrease amplitude of postoperative temperature,operating room temperature and operation time,and this model is significant for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM.