急诊行急性肠梗阻手术术中低体温危险因素分析及预测模型建立

Analysis of the risk factors of hypothermia during emergency treatment for acute intestinal obstruction and establishment of prediction model

目的:探讨急诊行急性肠梗阻手术术中低体温危险因素及构建风险模型。方法:回顾性分析行急诊肠梗阻手术的200例病人的临床资料。根据术中是否发生低体温,分为低体温组(68例)和非低体温组(132例)。收集病人的临床基线资料,包括年龄、性别和体质量指数(BMI);手术室监测指标,包括手术时间、术中灌洗量、术中出血量及是否采取复合保温措施;实验室指标:白蛋白和血红蛋白。采用独立样本t检验和χ^(2)检验进行单因素分析;采用二分类的logistic回归分析急性肠梗阻病人术中低体温的独立危险因素,并用ROC曲线对独立危险因素进行预测。结果:低体温组与非低体温组在年龄、性别、术中失血量、白蛋白及血红蛋白方面比较,差异均无统计学意义(P>0.05);低体温组的BMI、手术时间、术中灌洗量及复合保温措施与非低体温组比较,差异均有统计学意义(P<0.01);二元logistic回归分析显示,手术时间>2 h、术中灌洗量>4000 mL、未采取复合保温措施和BMI≤23 kg/m^(2)均是肠梗阻病人术中发生低体温的独立危险因素(P<0.01);基于二元logistic回归分析,对预测模型进行Hosmer-Lemeshow检验P=0.161,表明拟合良好;利用ROC曲线预测实际低体温的敏感度与特异度,显示曲线下面积为0.916,最佳截断值为0.680,灵敏度、特异度分别为0.794和0.886。结论:手术时间、术中灌洗量、复合保温措施、BMI均与急性肠梗阻病人术中发生低体温相关,建立风险预测模型可以更好的评估急性肠梗阻病人术中低体温的发生风险,为临床医务人员早期监测及预防提供参考意见。

Objective:To investigate the risk factors of hypothermia during emergency treatment for acute intestinal obstruction,and establish a risk model.Methods:The clinical data of 200 patients treated with emergency treatment for acute intestinal obstruction were retrospectively analyzed.According to whether hypothermia occurred during the operation,the patients were divided into the hypothermia group(68 cases)and non-hypothermia group(132 cases).The clinical baseline data(including age,sex and BMI),operating room monitoring indicators(including operation time,intraoperative lavage volume,intraoperative blood loss and whether composite insulation measures)and laboratory indicators(including albumin and hemoglobin levels)were collected.The independent sample t test andχ^(2)test were used for single factor analysis.Binary logistic regression was used to analyze the independent risk factors of intraoperative hypothermia in patients with acute ileus,and ROC curve was used to predict the independent risk factors.Results:There was no statistical significance in the age,sex,intraoperative blood loss,albumin and hemoglobin between the hypothermia group and non-hypothermia group(P>0.05).The differences of the BMI,operation time,intraoperative lavage volume and composite insulation measures between the hypothermia group and non-hypothermia group were statistically significant(P<0.05).The results of binary logistic regression analysis showed that the operation time more than 2 h,intraoperative lavage volume more than 4000 mL,no-taking composite insulation measure and BMI less than or equal to 23 kg/m^(2)were the independent risk factors of intraoperative hypothermia in patients with ileus(P<0.01).Based on binary logistic regression analysis,the Hosmer-Lemeshow test of prediction model showed P=0.161,whcih indicated the fit was good.The ROC curve was used to predict the sensitivity and specificity of actual hypothermia.The area under the curve was 0.916,the optimal cut-off value was 0.680,and the sensitivity and specificity were 0.794 and 0.886,respectively.Conclusions:The operation time,intraoperative lavage volume,composite insulation measures and BMI are related to the intraoperative hypothermia in patients with acute ileus.Establishing a risk prediction model can better evaluate the risk of intraoperative hypothermia in patients with acute ileus,and provide reference in the early monitoring and prevention of disease for clinical medical staff.