产妇腰麻后发生仰卧位低血压综合征的危险因素及其预测模型

Risk factors for supine hypotension syndrome after cesarean section and development of a prediction model in parturients

目的筛选产妇腰麻后发生仰卧位低血压综合征(SHS)的危险因素并建立预测模型。方法回顾性分析行择期剖宫产术产妇的病历资料, 根据腰麻后SBP下降30 mmHg或下降至80 mmHg以下标准, 将产妇分为非SHS组和SHS组。收集患者的一般资料、麻醉前体位变动时髂外静脉流量差值(ΔIVF)等, 将组间比较差异有统计学意义的因素纳入logistic回归模型, 筛选危险因素并建立加权评分回归预测模型, 绘制ROC曲线对模型进行评价。结果腰麻后发生SHS的产妇64例, 发生率54.7%。logistic回归分析显示:胎儿腹围、羊水指数、ΔIVF和去氧肾上腺素用量是产妇腰麻后发生SHS的独立危险因素。ROC曲线下面积为0.983, 95%CI为0.968~0.999, 灵敏度为90.6%, 特异度为96.2%, 约登指数为0.868。列线图预测模型经Hosmer-Lemshow检验, P=0.984, 可视化列线图模型C指数为0.983。结论胎儿腹围、羊水指数、ΔIVF和去甲肾上腺素用量是产妇腰麻后发生SHS的独立危险因素, 由此建立的风险预测模型可有效预测产妇腰麻后SHS的发生。

Objective To identify the risk factors for supine hypotension syndrome(SHS)after spinal anesthesia and establish a predictive model in parturients.Methods The medical records from pregnant women undergoing elective cesarean section were retrospectively analyzed.According to the standard that SBP dropped by 30 mmHg or below 80 mmHg after spinal anesthesia,the parturients were divided into non-SHS group and SHS group.The general data from patients and difference of external iliac vein flow(ΔIVF)during postural changes before anesthesia were collected.The factors with statistically significant differences between groups were included in the logistic regression model,the risk factors were identified and the weighted score regression prediction model was established,and the receiver operating characteristic curve was drawn to evaluate the model.Results There were 64 parturients developed SHS after spinal anesthesia,with an incidence of 54.7%.Logistic regression analysis showed that fetal abdominal circumference,amniotic fluid index,ΔIVF and consumption of norepinephrine were independent risk factors for SHS after spinal anesthesia.The area under the receiver operating characteristic curve was 0.983,95%confidence interval was 0.968-0.999,the sensitivity was 90.6%,the specificity was 96.2%,and the Youden index was 0.868.The prediction model of the line chart was tested by Hosmer-Lemshow,P=0.984,and the C index visualized the line chart model was 0.983.Conclusions Fetal abdominal circumference,amniotic fluid index,ΔIVF and consumption of norepinephrine are independent risk factors for SHS after spinal anesthesia in parturients,and the risk prediction model can effectively predict the occurrence of SHS after spinal anesthesia.