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护理学报 ›› 2023, Vol. 30 ›› Issue (20): 58-62.doi: 10.16460/j.issn1008-9969.2023.20.058

• 临床护理※外科护理 • 上一篇    下一篇

腹部消化系统手术患者术中低体温风险预测模型的构建与验证

方敏1,2, 高兴莲1, 柯稳1, 王曾妍1, 梁元元1,2   

  1. 1.华中科技大学同济医学院附属协和医院 手术室,湖北 武汉 430022;
    2.华中科技大学同济医学院 护理学院,湖北 武汉 430030
  • 收稿日期:2023-06-27 出版日期:2023-10-25 发布日期:2023-11-08
  • 通讯作者: 高兴莲（1968-）,女,湖北枣阳人,硕士,主任护师,总护士长。Email：sssgxl@163.com
  • 作者简介:方敏（1999-）,女,重庆人,本科学历,硕士研究生在读,护士。
  • 基金资助:
    湖北省自然科学基金（2020CFB776）

Establishment of risk prediction model for intraoperative hypothermia in patients undergoing abdominal surgery of digestive system and its validation

FANG Min1,2, GAO Xing-lian1, KE Wen1, WANG Ceng-yan1, LIANG Yuan-yuan1,2   

  1. 1. Operating Room, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China;
    2. School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2023-06-27 Online:2023-10-25 Published:2023-11-08

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摘要： 目的 探索腹部消化系统手术患者术中低体温的影响因素,构建预测模型,并对其预测效果进行检验。方法 使用方便抽样法,抽取我院2021年12月—2022年7月的395例接受腹部消化系统手术患者,根据手术过程中是否发生低体温分为低体温组（n=242）和非低体温组（n=153）。根据Logistic回归结果确定术中低体温影响因素,建立风险预测模型并绘制列线图,对模型进行区分度、校准度及临床有效性评价检验。结果 最终纳入手术间洁净度、手术分级、麻醉时间和手术开始时患者基础体温作为模型构建指标。模型最佳截断值为0.477时,ROC曲线下面积为0.901,灵敏性为0.793,特异性为0.830,约登指数为0.623,预测模型区分度较好;Hosmer-Lemeshow检验结果χ2=3.938,P=0.863,预测模型校准度较好;DCA决策曲线显示,该模型临床有效性较好。结论 构建的术中低体温风险预测模型对腹部消化系统手术患者术中低体温的发生具有较高的预测价值,可为手术团队人员对高风险患者及时采取低体温防治措施提供依据。

关键词: 低体温, 腹部消化系统手术, 影响因素, 风险预测, 手术室护理

Abstract: Objective To explore the factors influencing intraoperative hypothermia in patients undergoing abdominal surgery for digestive system, and to develop a risk prediction model and access its validity. Methods A total of 395 patients undergoing abdominal surgery for digestive system in our hospital from December 2021 to July 2022 were enrolled and allocated into hypothermia group （n=242）and non-hypothermia group（n=153） based on whether hypothermia occurred. The factors influencing intraoperative hypothermia were determined by logistic regression, and a risk prediction model was developed and plotted in a nomogramm, and the discrimination, calibration and clinical validity of the model were assessed. Result Four factors of the cleanliness of operating room, operation grade, anesthesia time and basic body temperature at the beginning of the operation were included in the model. When the best cut-off value of the model was 0.477, the area under the ROC curve was 0.901 with the sensitivity and the specificity of 0.793 and 0.830 respectively while the Youden index 0.623,showing that the prediction model was well differentiated. Hosmer-Lemeshow test showed χ2=3.938, P=0.863, indicating that prediction model was well calibrated. Decision curve analysis showed that the model has clinical effectiveness. Conclusion The constructed risk prediction model is of high value in predicting the occurrence of intraoperative hypothermia in patients undergoing abdominal surgery of digestive system. It provides reference for surgical team to take timely measures to prevent hypothermia for high-risk patients.

Key words: hypothermia, surgery of digestive system, influencing factor, risk prediction, nursing in operating room

中图分类号: 

  • R473.6
[1] Sessler DI,Lee KA,McGuire J.Isoflurane anesthesia and circadian temperature cycles in humans[J].Anesthesiology, 1991,75(6):985-989.DOI: 10.1097/00000542-199112000-00010.
[2] National Instituute for Health and Care Excellence.The management of inadvenent perioperative hypothermia in adults[EB/OL].(2018-08-29)[2023-03-09].http://www.nice.org.uk/guideance/cg65.
[3] Rauch S, Miller C, Brauer A, et al.Perioperative hypothermia-a narrative review[J]. Int J Environ Res Public Health, 2021,18(16):8749. DOI: 10.3390/ijerph18168749.
[4] Sessler DI.Perioperative thermoregulation and heat balance[J]. Lancet, 2016, 387(10038):2655-2664. DOI:10.1016/S0140-6736(15)00981-2.
[5] Ribeiro JC, Bellusse GC, Martins DF I, et al.Effect of perioperative hypothermia on surgical site infection in abdominal surgery: a prospective cohort study[J]. Int J Nurs Pract, 2021,27(4):e12934. DOI: 10.1111/ijn.12934.
[6] Cumin D, Fogarin J, Mitchell SJ, et al.Perioperative hypothermia in open and laparoscopic colorectal surgery[J]. ANZ J Surg,2022,92(5):1125-1131. DOI:10.1111/ans.17493.
[7] Sabbag IP, Hohmann FB, Assuncao M, et al.Postoperative hypothermia following non-cardiac high-risk surgery: a prospective study of temporal patterns and risk factors[J]. PLoS One, 2021,16(11):e259789. DOI:10.1371/journal.pone.0259789.
[8] 国家麻醉专业质量控制中心. 围术期患者低体温防治专家共识(2023版)[J]. 协和医学杂志, 2023,14(4):734-743. DOI: 10.12290/xhyxzz.2023-0266.
[9] Link T.Guidelines in practice: hypothermia prevention[J]. AORN J, 2020,111(6):653-666. DOI: 10.1002/aorn.13038.
[10] Chen HY, Su LJ,Wu HZ, et al.Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: a prospective cohort study[J]. PLoS One,2021,16(9):e257816.DOI:10.1371/journal.pone.0257816.
[11] 余文静, 肖瑶, 胡娟娟, 等. 预防围手术期患者低体温的最佳证据总结[J]. 中华护理杂志, 2019,54(4):589-594. DOI: 10.3761/j.issn.0254-1769.2019.04.023.
[12] 柯稳, 高兴莲, 余文静. 成人术中低体温发生风险预测工具和风险因素深度研究进展[J]. 护士进修杂志, 2022,37(22):2066-2071. DOI: 10.16821/j.cnki.hsjx.2022.22.010.
[13] 甘泳江, 陆芸芸. 空气洁净技术与手术部位感染预防的研究进展[J]. 中国医院建筑与装备, 2018,19(2):98-101. DOI: 10.3969/j.issn.1671-9174.2018.02.016.
[14] 黄培培, 米元元, 吴白女, 等. 肿瘤患者术中非计划性低体温预防及管理的证据总结[J]. 护理学报, 2018,25(21):33-39. DOI: 10.16460/j.issn1008-9969.2018.21.033.
[15] Horosz B, Malec-Milewska M.Inadvertent intraoperative hypothermia[J]. Anaesthesiol Intensive Ther, 2013,45(1):38-43. DOI: 10.5603/AIT.2013.0009.
[16] Madrid E, Urrutia G, Roque IFM, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J]. Cochrane Database Syst Rev,2016,4(4):CD009016.DOI:10.1002/14651858.CD009016.pub2.
[17] 董涛. 老年腹部全身麻醉手术患者术中低体温的影响因素[J]. 中国老年学杂志, 2020,40(6):1228-1231. DOI:10.3969/j.issn.1005-9202.2020.06.036.
[18] 章明阳, 杜李百合, 罗小平, 等. 术前患者预保温的最佳证据总结[J]. 护理学报,2020,27(6):17-22. DOI:10.16460/j.issn1008-9969.2020.06.017.
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