摘要
目的:建立无痛胃肠镜诊疗老年患者PACU低血压的预测模型并进行验证。方法:回顾性收集2021年3月至6月于苏北人民医院内镜中心行无痛胃肠镜诊疗老年患者的病历资料,性别不限,年龄≥60岁,ASA分级Ⅰ~Ⅲ级。按照3∶1的比例随机分为训练集和验证集,在训练集中通过Lasso回归筛选与PACU低血压相关的特征变量,将特征变量采用多因素logistic回归分析确定PACU低血压的独立危险因素,依此建立预测PACU低血压发生风险的列线图模型。分别通过校准曲线和受试者工作特征曲线验证模型的区分度、一致性和准确性,并采用决策曲线分析法确定模型的临床实用性,通过外部验证进行进一步评估。结果:最终纳入973例患者,有378例患者发生PACU低血压,发生率为38.8%。多因素logistic回归分析显示,年龄增长、术前禁水时间延长、诱导前后SBP变化百分比升高和术中MAP<65 mmHg是无痛胃肠镜诊疗老年患者PACU低血压的独立危险因素,术中使用去甲肾上腺素是保护因素(P<0.05)。依此构建列线图模型,受试者工作特征曲线下面积训练集为0.710(95%CI0.672~0.748),验证集为0.778(95%CI 0.720~0.837)。训练集与验证集校准曲线经Hosmer-Lemeshow拟合优度检验显示P值分别为0.399、0.062。决策曲线显示,预测模型在训练集和验证集的阈值概率分别为20%~82%和18%~92%。结论:基于年龄、术前禁水时间、诱导前后SBP变化百分比、术中MAP<65 mmHg情况和使用去甲肾上腺素情况,成功建立了无痛胃肠镜诊疗老年患者PACU低血压的列线图预测模型;该模型能可视化、个体化地对PACU低血压的风险进行预测。
Objective To develop and validate a predictive model for post-anesthesia care unit(PACU)hypotension in elderly patients undergoing painless gastrointestinal endoscopy.MethodsThe medical records of elderly patients of both sexes,aged≥60 yr,of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ,undergoing painless gastrointestinal endoscopy at the Endoscopy Center of Subei People′s Hospital from March to June 2021,were retrospectively collected.The patients were randomly divided into training and validation sets according to the ratio of 3∶1.In the training set,the characteristic variables associated with PACU hypotension were screened by Lasso regression,and the independent risk factors for PACU hypotension were identified by multivariate logistic regression analysis of the characteristic variables,according to which a nomogram model predicting the risk for PACU hypotension was established.The discrimination,calibration and accuracy of the model were evaluated by calibration curve and receiver operating characteristic(ROC)curve.And the clinical practicability of the model was determined by decision curve analysis and further assessed by external validation.ResultsOf the 973 patients ultimately included,378 patients experienced PACU hypotension,with an incidence of 38.8%.Multivariate logistic regression analysis showed that age,prolonged preoperative water deprivation time,increased percentage of changes in SBP before and after induction,and intraoperative MAP<65 mmHg were independent risk factors for hypotension in the PACU,and intraoperative use of norepinephrine was a protective factor.The nomogram model was then developed based on the results.The area under the ROC curve was 0.710(95%confidence interval[CI]0.672-0.748)in training set and 0.778(95%CI 0.720-0.837)in validation set.In training and validation sets,the calibration curves were tested by Hosmer-Lemeshow good of fit test,the P values were 0.590 and 0.950,respectively.The decision curve analysis curve showed that the risk threshold of the prediction model in the training and validation sets were between 20%and 82%and between 18%and 92%,respectively,in the external validation.ConclusionsThe nomogram model for prediction of PACU hypotension is successfully established based on age,prolonged preoperative water deprivation,percentage of change in SBP before and after induction,intraoperative MAP<65 mmHg and use of norepinephrine in elderly patients undergoing painless gastrointestinal endoscopy,and the model can visually and individually predict the risk of PACU hypotension.
作者
王梓
刘昕
庞智方
高巨
Wang Zi;Liu Xin;Pang Zhifang;Gao Ju(Department of Anesthesiology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Anesthesiology,Hongquan Hospital,Yangzhou 225001,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2023年第5期519-525,共7页
Chinese Journal of Anesthesiology
基金
国家自然科学基金(82172190)
江苏省卫生健康委员会医学科研项目面上项目(M2021105)
扬州市重点实验室培育专项基金(YZ20211148)。
关键词
老年人
内窥镜检查
胃肠道
低血压
苏醒室
预测
Aged
Endoscopy,gastrointestinal
Hypotension
Recovery room
Forecasting
