不停跳冠状动脉旁路移植患者术中低体温风险预测模型的构建

doi:10.3761/j.issn.0254-1769.2023.20.007

摘要/Abstract

摘要：

目的探讨非体外循环下不停跳冠状动脉旁路移植术患者术中低体温的危险因素，构建列线图预测模型。方法采用便利抽样法，选取2019年1月—2021年6月在北京市某三级甲等医院住院的202例不停跳冠状动脉旁路移植术患者，依据术中是否发生低体温分为低体温组（n=103）和非低体温组（n=99），通过电子病历系统收集相关术前资料，采用Logistic回归分析危险因素，利用R软件绘制不停跳冠状动脉旁路移植术患者术中低体温列线图预测模型，Hosmer-Lemeshow检验判断模型的拟合优度，受试者操作特征曲线下面积检测模型的预测效果。结果不停跳冠状动脉旁路移植术患者术中低体温发生率为50.99%，术中低体温列线图预测模型中纳入5个危险因素，分别为年龄、体表面积、术前射血分数、手术室室温和消毒开始时体温。该模型的Hosmer-Lemeshow检验结果显示，受试者操作特征曲线下面积为0.840（95%CI为0.787~0.894），最佳临界值为0.344，灵敏度为0.903，特异度为0.616，模型外部验证准确率为78.22%，提示模型具有较好的拟合效果和较高的预测价值。结论不停跳冠状动脉旁路移植术患者术中低体温发生率较高，该研究构建的列线图模型能早期、高效预测患者术中低体温发生的风险，为术中低体温的早期评估及有效预防提供科学依据。

关键词: 不停跳冠状动脉旁路移植术, 低体温, 危险因素, 列线图, 预测模型, 围手术期护理

Abstract:

Objective To investigate the preoperative risk factors of intraoperative hypothermia in patients undergoing off-pump coronary artery bypass grafting（OPCABG），and to construct a nomogram prediction model. Methods A total of 202 patients undergoing OPCABG in a tertiary hospital in Beijing from January 2019 to June 2021 were selected by convenience sampling. The patients were divided into a hypothermia group（n=103） and a non-hypothermia group（n=99） according to whether they had hypothermia during operation. Relevant preoperative data were collected through the hospital electronic medical record system. Logistic regression was used to analyze risk factors. R software was used to draw a nomogram prediction model for intraoperative hypothermia in patients undergoing OPCABG. Hosmer-Lemeshow test was used to judge the goodness of fit of the model. The area under ROC curve was used to detect the predictive effect of the model. Results The incidence of intraoperative hypothermia in patients undergoing OPCABG was 50.99%. 5 factors were included in the intraoperative hypothermia nomogram prediction model，namely age，body surface area，ejection fraction，operating room temperature and body temperature at the beginning of disinfection. The Hosmer-Lemeshow test results of the model showed that P=0.471； the area under the ROC curve was 0.840（0.787~0.894）；the optimal critical value was 0.344；the sensitivity was 0.903；the specificity was 0.616；the accuracy of external validation was 78.22%. They suggested that the model had good fitting effect and high predictive value. Conclusion The incidence of intraoperative hypothermia in patients undergoing OPCABG is high. The nomogram model constructed based on preoperative risk factors in this study can predict the risk of intraoperative hypothermia in patients undergoing OPCABG early and efficiently. It provides a scientific basis for clinical nursing staff to evaluate and effectively prevent intraoperative hypothermia.

Key words: Off-Pump Coronary Artery Bypass Grafting, Low Body Temperature, Risk Factors, Nomogram, Prediction Model, Periopetative Nursing

刘婷, 王林, 郝艳丽, 曹朋, 王冉. 不停跳冠状动脉旁路移植患者术中低体温风险预测模型的构建[J]. 中华护理杂志, 2023, 58(20): 2481-2487.

LIU Ting, WANG Lin, HAO Yanli, CAO Peng, WANG Ran. Construction of a preoperative risk prediction nomogram model for hypothermia during off-pump coronary artery bypass graftin[J]. Chinese Journal of Nursing, 2023, 58(20): 2481-2487.

图/表 6

表1 不停跳冠状动脉旁路移植术患者术中低体温单因素分析结果（n=202）

Table 1 Univariate analysis of intraoperative hypothermia in OPCABG patients（n=202）

表2 自变量赋值

Table 2 Risk factor assignment table

表3 不停跳冠状动脉旁路移植术患者术中低体温的Logistic回归分析结果（n=202）

Table 3 Logistic regression analysis of preoperative risk factors（n=202）

图1 不停跳冠状动脉旁路移植术患者术中低体温预测列线图

Figure 1 Predictive nomogram of intraoperative hypothermia in OPCABG patients

图2 不停跳冠状动脉旁路移植术患者术中低体温风险预测模型的ROC曲线

Figure 2 ROC curve of intraoperative hypothermia risk prediction model for OPCABG patients

图3 不停跳冠状动脉旁路移植术患者术中低体温风险预测模型的校准曲线

Figure 3 Calibration curve of intraoperative hypo-thermia risk prediction model for OPCABG patients

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