全麻患者围手术期低体温风险预测模型的前瞻性、多中心研究

A Prediction Model for Estimating Risk of Intraoperative Hypothermia in Patients Undergoing General Anesthesia:A Prospective Multicenter Study

目的采用低体温风险预测模型评估围手术期低体温的准确性。方法纳入2019年10月至2021年8月在北京协和医院、北京医院和首都医科大学宣武医院择期行手术的全麻患者,美国麻醉医师学会分级Ⅰ~Ⅲ级,年龄≥18岁。通过围手术期低体温风险预测模型计算每例患者的风险因子得分,并在患者围手术期全程监测体温,保温措施由麻醉医生自行决定。采用受试者工作特征曲线的曲线下面积(AUC)、Hosmer-Lemeshow拟合优度检验和Brier评分评价低体温风险模型的预测性能。结果在纳入分析的472例患者中,术中低体温发生率29.9%(141/472),术中采用主动保温率为26.3%(124/472)。通过验证,该模型具有良好的预测能力。在472例患者中,模型预测术中低体温AUC=0.729(95%CI=0.680~0.777);Hosmer-Lemeshowχ^(2)=3.143,P=0.925;Brier评分0.34。其中非主动保温的患者中,模型预测AUC=0.756(95%CI=0.704~0.808);Hosmer-Lemeshowχ^(2)=7.457,P=0.488;Brier评分0.29。而主动保温的患者,模型预测AUC=0.747(95%CI=0.632~0.863);Hosmer-Lemeshowχ^(2)=4.754,P=0.783;Brier评分0.47。进一步将低体温风险分为低、中、高风险组后,术中低体温发生率分别为14.4%(95%CI=9.6%~19.1%)、36.7%(95%CI=29.9%~43.5%)和58.2%(95%CI=46.1%~70.3%),3组比较差异有统计学意义(χ^(2)=54.112,P<0.001)。结论围手术期低体温风险预测模型总体区分度较好,不论是否实施主动保温患者,该风险预测模型均有一定的预测准确性。

Objective To validate the performance of the model for predicting the risk of intraoperative hypothermia.Methods This observational prospective study enrolled the adult patients who were of American Society of AnesthesiologistsⅠ-Ⅲand underwent elective surgery with general anesthesia in Peking Union Medical College Hospital,Beijing Hospital,and Xuanwu Hospital of Capital Medical University from October 2019 to August 2021.The risk prediction model of intraoperative hypothermia was used to calculate the predictors score of each patient.The body temperature of each patient was monitored throughout the perioperative period,and perioperative temperature management were entirely at the discretion of the anesthesiologists.The area under the receiver operating characteristic curve(AUC),Hosmer-Lemeshow goodness-of-fit test,and Brier score were employed to evaluate the prediction performance of the model.Results Of the 472 participants included in this study,141(29.9%)developed intraoperative hypothermia and 124(26.3%)received intraoperative active warming.For predicting intraoperative hypothermia in the overall cohort,the model demonstrated good discrimination capacity with an AUC of 0.729(95%CI=0.680-0.777),adequate calibration(Hosmer-Lemeshowχ^(2)=3.143,P=0.925),and good overall performance(Brier score of 0.34).For the patients with passive warming only,the model showed good discrimination(AUC=0.756;95%CI=0.704-0.808),good calibration(Hosmer-Lemeshowχ^(2)=7.457,P=0.488),and the Brier score of 0.29.For the patients with active warming,the model presented the AUC of 0.747(95%CI=0.632-0.863),Hosmer-Lemeshowχ^(2) of 4.754(P=0.783)and the Brier score of 0.47.Furthermore,we stratified the risk scores as low,moderate and high risk groups,in which the incidence of intraoperative hypothermia was 14.4%(95%CI=9.6%-19.1%),36.7%(95%CI=29.9%-43.5%),and 58.2%(95%CI=46.1%-70.3%),respectively.The differences between the three groups were statistically significant(χ^(2)=54.112,P<0.001).Conclusion The intraoperative hypothermia prediction model demonstrates good overall differentiation capacity and has good prediction performance for the patients with or without active warming.