剖宫产术麻醉中产妇低体温风险的列线图预测模型建立及分析

Establishment and analysis of nomogram prediction model for the hypothermia risk of women during anesthesia of cesarean section

目的:探讨影响剖宫产麻醉中(CD)产妇发生低体温风险的影响因素,并构建列线图预测模型进行验证。方法:回顾性分析2020年7月-2021年7月本院实施CD产妇196例临床资料,在麻醉中发生低体温98例产妇为低体温组,非低体温98例产妇为对照组,比较两组临床资料,采用单因素和多因素logistic回归分析筛选出影响CD麻醉中产妇低体温的独立危险因素,绘制列线图并进行验证。结果:多因素分析表明,甲状腺功能减退,腰麻,麻醉后体温<36.75℃,术中产妇体液丢失量>980ml,没用采取主动保温,主动保温持续时间<30min,没有采取输液加温,进入手术室室温≤23℃,术中室温≤23℃是影响CD麻醉中产妇低体温的独立危险因素(P<0.05)。校准图和受试者工作特征曲线(ROC)的C指数和曲线下面积分别为0.843和0.852,提示列线图模型结果与实际结果有良好一致性。结论:甲状腺功能减退,腰麻,麻醉后体温<36.75℃,术中产妇体液丢失量>980ml,没用采取主动保温,主动保温持续时间<30 min,没有采取输液加温,进入手术室室温≤23℃,术中室温≤23℃是影响CD麻醉中产妇低体温的独立危险因素,为预防CD产妇体温过低制定策略提供参考。

Objective: To investigate the risk factors of the hypothermia risk of women during anesthesia of cesarean section, and to verification by the established nomogram prediction model of the hypothermia. Methods: The clinical data of 196 women who had undergone cesarean section from July 2020 to July 2021 were analyzed retrospectively. Among them, 98 women with hypothermia were included in group A, and another 98 women without hypothermia were included in group B. The clinical data of the women were compared between the two groups. Univariate and multivariate logistic regression analysis were used to screen out the independent risk factors affecting the hypothermia occurrence of the women during anesthesia of cesarean section, and the nomogram was drawn to verify these risk factors. Results: Multivariate analysis showed that the hypothyroidism, the lumbar anesthesia, the body temperature after anesthesia <36.75℃, the intraoperative fluid loss >980ml, no active heat preservation, the duration of active heat preservation <30min, no infusion heating, the room temperature ≤23℃ when entering the operating room, and the operating room temperature ≤23℃ during operation of the women were their independent risk factors of hypothermia during anesthesia of cesarean section(P<0.05). The C index and the area under of the calibration chart and the receiver operator characteristic(ROC) were 0.843 and 0.852, which indicating that the results of the nomogram prediction model of hypothermia had good consistency with the actual results. Conclusion: The hypothyroidism, the lumbar anesthesia, the body temperature after anesthesia <36.75℃, the intraoperative fluid loss >980ml, no active heat preservation,the duration of active heat preservation <30 min,no infusion heating,the room temperature ≤23℃ when entering the operating room,and the operating room temperature≤23℃ during operation of the women are their independent risk factors of hypothermia during anesthesia of cesarean section,which can provide reference for formulating strategies to prevent the hypothermia of the women after cesarean section.