腔镜下甲状腺癌根治术患者术中低体温的危险因素分析及列线图模型构建

Risk factors of intraoperative hypothermia in patients undergoing radical thyroidectomy under laparoscopy and the construction of nomogram model

目的 分析腔镜下甲状腺癌根治术患者术中低体温的危险因素并构建列线图预测模型。方法 选取336例腔镜下甲状腺癌根治术患者作为研究对象,根据术中体温分为低体温组195例和正常体温组141例。采用Logistic回归模型分析腔镜下甲状腺癌根治术患者术中低体温的危险因素,再利用R软件构建列线图预测模型,通过受试者工作特征(ROC)曲线、校准曲线、Hosmer-Lemeshow拟合优度检验评估列线图预测模型的预测效能。结果 2组患者的年龄、术中出血量、液体输入量、手术时间比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄>60岁、术中出血量>60 mL、液体输入量>1 000 mL、手术时间>2.5 h为腔镜下甲状腺癌根治术患者术中低体温的危险因素(P<0.05);依据4项危险因素构建列线图预测模型,ROC曲线显示曲线下面积为0.912(95%CI:0.884~0.941),校准曲线、Hosmer-Lemeshow拟合优度检验结果显示校准曲线斜率接近1(χ^(2)=9.140,P=0.243)。结论 基于年龄、术中出血量、液体输入量、手术时间构建的列线图预测模型,对腔镜下甲状腺癌根治术患者术中低体温具有较好的预测价值。

Objective To analyze the risk factors of intraoperative hypothermia in patients undergoing radical thyroidectomy under laparoscopy and to construct a nomogram prediction model.Methods A total of 336 patients who underwent laparoscopic radical thyroidectomy were selected as study subjects.According to intraoperative body temperature,they were divided into hypothermia group(195 cases) and normal temperature group(141 cases).The risk factors of intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy were analyzed using the Logistic regression model.The nomogram prediction model was constructed using R software.The prediction performance of the nomogram prediction model was evaluated using the receiver operating characteristic(ROC) curve,calibration curve,and Hosmer-Lemeshow goodness-of-fit test.Results There were significant differences in age,intraoperative blood loss,amount of fluid infusion,and operation time between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age>60 years,intraoperative blood loss >60 mL,amount of fluid infusion>1 000 mL,and operation time>2.5 h were risk factors for intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy(P<0.05).A nomogram prediction model was constructed based on the four risk factors.The ROC curve showed that the area under the curve was 0.912(95%CI,0.884 to 0.941).The calibration curve and Hosmer-Lemeshow goodness-of-fit test showed that the slope of the calibration curve was close to 1( χ^(2)= 9.140,P = 0.243).Conclusion The nomogram prediction model based on age,intraoperative blood loss,amount of fluid infusion,and operation time has good predictive value for intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy.