高龄产妇椎管内阻滞后脊神经损伤影响因素的列线图预测模型构建

Construction of a nomogram prediction model for the influencing factors for spinal nerve injury in elderly parturients after intraspinal block

目的建立预测高龄产妇椎管内阻滞后脊神经损伤影响因素的列线图模型。方法选取2019年2月—2021年12月进入我院分娩行椎管内阻滞的高龄产妇480例,采用Lasso回归分析筛选高龄产妇椎管内阻滞后脊神经损伤的影响因素,采用logistic回归分析构建高龄产妇椎管内阻滞后脊神经损伤影响因素的预测模型,用R软件将模型可视化,并对高龄产妇椎管内阻滞后脊神经损伤影响因素的列线图模型进行验证。结果480例高龄产妇中,62例椎管内阻滞后发生脊神经损伤,脊神经损伤发生率为12.92%。Lasso回归分析结果显示,麻醉穿刺过程是否顺利、麻醉方式、分娩期间阴道出血量、麻醉时蛛网膜下腔有无异物感、有无高血压及有无糖尿病是椎管内阻滞后脊神经损伤的影响因素。由上述因素构建预测模型,模型的C-index为0.754,AUC为0.736,校正曲线显示实际值与预测值拟合度良好,决策曲线显示阈值概率在4%~67%时,采用列线图预测高龄产妇椎管内阻滞后脊神经损伤具有较高的净获益值。结论麻醉穿刺异常、腰硬联合麻醉、分娩期间阴道出血量≥300 mL、麻醉时蛛网膜下腔异物感、高血压及糖尿病等是高龄产妇椎管内阻滞后脊神经损伤的危险因素,基于以上6项预测因素建立的列线图有利于筛查高龄产妇中椎管内阻滞后脊神经损伤高风险者,并提前制定科学的防治措施。

Objective To establish a nomogram model for predicting the influence factors for spinal nerve injury in elderly parturients after intraspinal block.Methods A total of 480 elderly parturients who received intraspinal block for delivery in our hospital from February 2019 to December 2021 were enrolled.The Lasso regression analysis was used to identify the influencing factors for spinal nerve injury after intraspinal block in elderly parturients,and the logistic regression analysis was used to construct a predictive model for the influencing factors for spinal nerve injury caused by intraspinal block in elderly parturients.R software was used to visualize the model and validate the nomogram model for the influencing factors for spinal nerve injury caused by intraspinal block in elderly parturients.Results Among the 480 elderly parturients,62 experienced spinal nerve injury due to intraspinal block,and the incidence rate of spinal nerve injury was 12.92%.The Lasso regression analysis showed that whether the puncture process for anesthesia was smooth,anesthesia method,the amount of vaginal bleeding during delivery,the presence or absence of foreign body sensation in subarachnoid space during anesthesia,and the presence or absence of hypertension and diabetes were influencing factors for spinal nerve injury after intraspinal block.A prediction model was constructed based on the above factors,with a C-index of 0.754 and an AUC of 0.736.The calibration curve showed a good degree of fitness between the actual value and the predicted value,and the decision curve showed that at the threshold probability of 4%-67%,the nomogram model had a higher net benefit value in predicting spinal nerve injury after intraspinal block in elderly parturients.Conclusion Abnormal anesthesia puncture,combined spinal-epidural analgesia,vaginal bleeding≥300 mL during delivery,foreign body sensation in su-barachnoid space during anesthesia,hypertension,and diabetes are influencing factors for spinal nerve injury after intraspinal block in elderly parturients.The nomogram model based on the above 6 predictive factors can help to identify the elderly parturients at a high risk of spinal nerve injury due to intraspinal block and formulate scientific prevention and control measures in advance.