摘要
目的分析全麻患者术后并发症发生的相关因素,并根据相关因素构建预测模型,以期根据此模型降低全麻患者术后并发症的发生率。方法选取2021-02-01-2022-02-28方城县人民医院行全麻手术的患者228例为研究对象,分析其术后并发症发生的相关因素,以全麻患者术后并发症发生为因变量,一般资料作为自变量。对228例全麻患者术后是否发生并发症进行描述,根据是否发生并发症分为发生组(54例)和未发生组(174例),对比2组一般资料,将所有因素采用χ^(2)检验先进行单因素分析,筛选出有意义的变量,进行二分类logistic回归分析找出全麻患者术后并发症发生的独立危险因素,并根据所分析的因素构建预测模型。结果228例全麻患者中54例患者出现术后并发症,并发症发生率为23.68%。单因素分析结果显示,年龄(χ^(2)=8.816,P=0.003)、吸烟史(χ^(2)=32.559,P<0.001)、饮酒史(χ^(2)=20.920,P=0.003)、药物滥用史(χ^(2)=44.258,P<0.001)、美国麻醉医师协会(ASA)分级(χ^(2)=38.740,P<0.001)、术前是否存在焦虑(χ^(2)=41.213,P<0.001)、术前睡眠是否充足(χ^(2)=37.776,P<0.001)、手术时间(χ^(2)=31.505,P<0.001)、术中是否出现低体温(χ^(2)=33.758,P<0.001)、术中失血量(χ^(2)=41.392,P=0.003)、白细胞计数(χ^(2)=34.968,P<0.001)、肺功能(χ^(2)=14.618,P<0.001)术后并发症发生差异有统计学意义。logistic回归分析结果显示,年龄(OR=8.976,95%CI为5.772~15.432)、吸烟史(OR=10.029,95%CI为8.766~18.962)、饮酒史(OR=5.828,95%CI为3.998~9.001)、药物滥用史(OR=5.631,95%CI为3.424~8.935)、手术时间(OR=6.887,95%CI为4.298~11.392)、术中是否出现低体温(OR=8.334,95%CI为5.098~14.987)、白细胞计数(OR=8.765,95%CI为5.767~15.423)、肺功能(OR=9.097,95%CI为6.631~15.445)为全麻患者术后并发症发生的独立因素。按照多因素结果建立模型,绘制ROC曲线发现,预测模型得到的预测值用于预测全麻患者术后并发症发生风险的AUC为0.811(>0.7),有一定预测价值,Cut-off值取1.932时可获得最佳预测效能,对应的95%CI、标准误、P值、特异度、灵敏度、约登指数分别为0.700~0.915、0.032、<0.001、0.830、0.812、0.674。结论全麻患者术后并发症的发生受多种因素的共同影响,包括年龄、吸烟史、饮酒史、药物滥用史、手术时间、术中是否出现低体温、白细胞计数、肺功能等,所制定预测模型可早期预测术后并发症的发生。
Objective To observe relevant factors of postoperative complications in general anesthesia and constructed predictive models according to relevant factors to reduce the incidence of postoperative complications in general anesthesia according to this model.Methods A total of 228 patients who received general anesthesia surgery in our hospital from February 1,2021 to February 28,2022 were selected.In order to comprehensively analyze the relevant factors of postoperative complications in patients with general anesthesia,the incidence of postoperative complications in patients with general anesthesia was used as the dependent variable.General data of patients with general anesthesia were used as independent variables.The 228 cases of general anesthesia patients with postoperative complications were described,and they were divided into the occurrence group(54 cases)and the non-occurrence group(174 cases)according to whether complications occurred.All factors were analyzed byχ^(2)test firstly to screen out significant variables,and then binary logistic regression analysis was performed to find out the independent risk factors for postoperative complications in patients with general anesthesia,and a predictive model was constructed based on the analyzed factors.Results Fifty-four of the 228 general anesthesia patients developed postoperative complications,with a complication rate of 23.68%.Univariate results showed that age(χ^(2)=8.816,P=0.003),smoking history(χ^(2)=32.559,P<0.001),drinking history(χ^(2)=20.920,P=0.003),drug abuse history(χ^(2)=44.258,P=0.003),American Society of Anesthesiologists(ASA)classification(χ^(2)=38.740,P<0.001),preoperative anxiety(χ^(2)=41.213,P<0.001),adequate preoperative sleep(χ^(2)=37.776,P=0.000),operation time(χ^(2)=31.505,P<0.001),intraoperative hypothermia(χ^(2)=33.758,P<0.001),intraoperative blood loss(χ^(2)=41.392,P=0.003),white blood cell count(χ^(2)=34.968,P<0.001),pulmonary function(χ^(2)=14.618,P<0.001)had statistically significant difference with postoperative complications.logistic regression analysis showed that age(OR=8.976,95%CI:5.772-15.432),smoking history(OR=10.029,95%CI:8.766-18.962),drinking history(OR=5.828,95%CI:3.998-9.001),history of drug abuse(OR=5.631,95%CI:3.424-8.935),operation time(OR=6.887,95%CI:4.298-11.392),hypothermia during operation(OR=8.334,95%CI:5.098-14.987),white blood cell count(OR=8.765,95%CI:5.767-15.423),lung function(OR=9.097,95%CI:6.631-15.445)were independent factors for postoperative complications in patients with general anesthesia.According to the multivariate results,the ROC curve found that the AUC of the predictive value obtained by the predictive model in predicting the risk of postoperative complications in patients under general anesthesia was 0.811,which has a certain predictive value;the best prediction efficiency could be obtained when the cut off value was 1.932;the corresponding 95%CI,standard error,Pvalue,specificity,sensitivity,yoden index were 0.700-0.915,0.032,<0.001,0.830,0.812 and 0.674,respectively.Conclusions The occurrence of postoperative complications in patients with general anesthesia is jointly affected by many factors,including age,smoking history,drinking history,drug abuse history,operation time,hypothermia during operation,white blood cell count,lung function,etc.The constructed model can predict the occurrence of postoperative complications early.
作者
张莲
姬荣凡
ZHANG Lian;JI Rong-fan(Department of Anesthesiology,Fangcheng County People's Hospital,Fangcheng 473200,China)
出处
《社区医学杂志》
CAS
2022年第16期923-928,共6页
Journal Of Community Medicine
关键词
全麻
术后并发症
因素
预测模型
general anesthesia
postoperative complications
factors
predictive model
