巴楚医学

目的:探讨老年骨科手术患者术中低体温发生的独立影响因素,构建预测模型并进行内部验证。方法:选取2023年1月—2024年12月于宜昌市中心人民医院就诊的老年骨科全麻手术患者147例,按术中是否发生低体温,分成机体核心体温<36℃的低体温组(n=43)和机体核心体温≥36℃的非低体温组(n=104),比较两组患者临床资料,采用多因素Logistic回归模型分析老年骨科全麻手术患者术中低体温发生的独立影响因素并构建列线图模型,绘制校准曲线、决策曲线、受试者工作特征(ROC)曲线。结果:多因素Logistic回归分析结果提示,年龄(OR=1.823,95%CI:1.281,2.593)、身体质量指数(BMI)(OR=0.281,95%CI:0.119,0.665)、糖尿病(OR=4.284,95%CI:1.155,15.899)、麻醉时间(OR=1.119,95%CI:1.008,1.242)是老年骨科全麻手术患者术中低体温发生的独立影响因素(均P<0.05)。校正曲线、决策曲线提示列线图模型可靠,ROC曲线结果显示,联合预测术中低体温曲线下面积为0.962,敏感度为88.37%,特异度为90.38%,H-L拟合优度检验显示模型拟合度好(P=0.886)。结论:年龄、BMI、糖尿病、麻醉时间是老年骨科全麻手术患者术中低体温发生的独立影响因素,该预测模型对术中低体温的预测效能良好。

Objective: To explore the independent influencing factors of intraoperative hypothermia in elderly orthopedic patients and to construct and internally validate a predictive model. Methods: A total of 147 elderly patients who underwent general anesthesia surgery of orthopedic at Yichang Central People's Hospital from January 2023 to December 2024 were selected. They were divided into hypothermia group with a core body temperature of <36 ℃(n=43) and non-hypothermia group with a core body temperature of ≥36 ℃(n=104) based on whether intraoperative hypothermia occurred. Clinical data of the two groups were compared, and a multivariate Logistic regression model was used to analyze the independent influencing factors of intraoperative hypothermia in elderly patients undergoing general anesthesia surgery of orthopedic and to construct a nomogram model. Calibration curves, decision curves, and receiver operating characteristic(ROC) curves were drawn. Results: Multivariate Logistic regression analysis indicated that age(OR=1.823,95%CI:1.281,2.593), body mass index(BMI)(OR=0.281,95%CI:0.119,0.665), diabetes(OR=4.284,95%CI:1.155,15.899), and anesthesia duration(OR =1.119,95%CI:1.008,1.242)were independent influencing factors for intraoperative hypothermia in elderly orthopedic patients undergoing general anesthesia(all P<0.05). Calibration and decision curves suggested that the nomogram model was reliable, and the ROC curve results showed that the area under curve for combined prediction of intraoperative hypothermia was 0.962, with a sensitivity of 88.37% and a specificity of 90.38%. The H-L goodness-of-fit test indicated good model fit(P =0.886). Conclusion: Age, BMI, diabetes, and anesthesia duration are independent influencing factors for intraoperative hypothermia in elderly orthopedic patients undergoing general anesthesia. This risk prediction model has good predictive efficacy for intraoperative hypothermia.