消化道肿瘤患者术中低体温预测模型构建与验证

Construction and validation of a prediction model of intraoperative hypothermia in patients with gastrointestinal tumors

目的构建消化道肿瘤患者术中低体温预测模型并验证其预测效果。方法采用便利抽样法,选取2021年3月至6月于空军军医大学西京医院胃肠外科接受消化道肿瘤手术治疗的患者495例,其中男性340例,女性155例;年龄20~85(59.64±11.31)岁。将入组患者按2∶1比例随机分配至建模组和验证组。通过建模组数据探讨消化道肿瘤手术患者术中低体温发生情况,绘制受试者工作特征(ROC)曲线进行预测模型构建,利用验证组数据进行模型验证。结果建模组与验证组术中低体温实际发生率分别为32.7%(108/330)和36.4%(60/165);最终进入预测模型的因子分别为:手术类型为胃癌根治术(OR=0.097)、手术方式为腹腔镜(OR=3.642)、室温(OR=0.158)、采取主动保温措施(OR=0.105)。Hosmer-Lemeshow检验P=0.589,ROC曲线下面积为0.865,95%CI:0.823~0.906,约登指数为0.608,敏感度为0.806,特异度为0.802。实际应用正确率为83.03%。结论手术类型为胃癌根治术、手术方式为腹腔镜、室温及是否采取主动保温措施是发生术中低体温的独立危险因素。建立术中低体温发生风险预测模型可有效预测消化道肿瘤患者术中低体温的发生风险。本研究构建的预测模型效果良好,可为临床筛选消化道肿瘤手术术中低体温高危患者提供参考。

Objective To establish a prediction model of intraoperative hypothermia in patients with gastrointestinal tumors and verify its prediction effect.Methods A total of 495 patients(340 males and 155 females)who received surgical treatment for gastrointestinal tumors were selected from the Department of Gastrointestinal Surgery,Xijing Hospital,Air Force Medical University from March to June 2021 by convenience sampling method.The age ranged from^(2)0 to 85(59.64±11.31)years old.The enrolled patients were randomly assigned to the modeling group and the validation group in a ratio of 2∶1.The occurrence of intraoperative hypothermia in patients undergoing gastrointestinal tumor surgery was analyzed through the data of the modeling group,the receiver operating characteristic curve(ROC)was drawn to construct a prediction model,and the data of the validation group was used to verify the model.Results The actual incidence of intraoperative hypothermia was 32.7%(108/330)in the modeling group and 36.4%(60/165)in the validation group.Finally,the factors entering the prediction model were radical gastrectomy(OR=0.097),laparoscopy-assisted surgery(OR=3.642),room temperature(OR=0.158),and active warming measures(OR=0.105).In Hosmer-Lemeshow test,P was 0.589,area under the ROC curve was 0.865,95%CI was 0.8230.906,and Youden s index was 0.608,with sensitivity of 0.806 and specificity of 0.802.The accuracy of actual application was 83.03%.Conclusion Radical gastrectomy,laparoscopy-assisted surgery,room temperature and whether to take active warming measures are independent risk factors for intraoperative hypothermia.The establishment of a risk prediction model for intraoperative hypothermia can effectively predict the risk of intraoperative hypothermia in patients undergoing gastrointestinal tumor surgery.The prediction model established in this study has a good effect,which can provide reference for clinical screening of high-risk patients with hypothermia during gastrointestinal tumor surgery.