妇科腹腔镜手术患者低体温风险预测模型的构建与验证OA

Objective To construct and validate a risk prediction model for hypothermia in patients undergoing gynecologi-cal laparoscopic surgery.Methods The clinical data of 452 patients who underwent gynecological laparoscopic surgery at Yangzhou Maternal and Child Health Hospital Affiliated to Yangzhou University Medical College from September 2023 to June 2024 were retrospectively analyzed.A total of 301 patients admitted from September 2023 to March 2024 were assigned as the modeling group,and 151 patients admitted from April to June 2024 were assigned as the validation group.According to whether hypothermia occurred,patients in the modeling group were divided into the hypothermia group(n=94)and the non-hypothermia group(n=207).The data of the two groups were analyzed.Variables with statistically significant differences identified by univariate analysis were subjected to logistic regression analysis to obtain a regression equation.The Hosmer-Lemeshow test was used to evaluate the performance of the hypothermia prediction model.The ROC curve was used to assess sensitivity and specificity.External validation was performed using the validation group to evaluate the generaliz-ability of the prediction model in real clinical settings.Results The probability of hypothermia in 301 patients undergoing gynecological laparoscopic surgery was 31.23％(94/301).Univariate analysis showed statistically significant differences between the two groups in American Society of Anesthesiologists(ASA)grade,age,anesthesia duration,operative time,blood loss volume,body mass index(BMI),systolic blood pressure,diastolic blood pressure,pulse pressure,mean arterial pressure(MAP),heart rate,duration of pneumoperi-toneum use,and baseline body temperature(P＜0.05).Multivariate logistic analysis showed that ASA grade Ⅲ(β=3.219,OR=24.991,95％CI:2.952-211.596),operative time(β=0.062,OR=1.064,95％CI:1.015-1.115),blood loss volume(β=-0.007,OR=0.993,95％CI:0.987-0.999),and baseline body temperature(β=-2.482,OR=0.084,95％CI:0.008-0.867)were influencing factors for hypothermia in patients undergoing gynecological laparoscopic surgery(P＜0.05).A predic-tive model for hypothermia in patients undergoing gynecological laparoscopic surgery was constructed(equation:Y=-8.212+3.219 × ASA grade[Ⅲ grade=l,Ⅱ grade=0]+0.062 × operative time-0.007 × blood loss volume-2.482 × baseline body temperature).Internal and external validation were performed.The Hosmer-Lemeshow goodness of fit test showed P＞0.05,indicating good model fit.The ROC results showed that the area under the curve of this model for predicting hypothermia in patients undergoing gynecological laparoscopic surgery was 0.949(95％CI:0.927-0.972)and 0.782(95％CI:0.708-0.856),respectively.Conclusion The gynecological laparoscopic surgery patient hypothermia risk prediction model constructed based on ASA classification,operation duration,blood loss,and basal body temperature has high value.