摘要
目的探讨先天性心脏病患儿体外循环复温后再次发生低体温的危险因素,建立个体化预测其术后发生低体温风险的列线图模型。方法回顾分析2019年1月1日至2019年4月30日因先天性心脏病行体外循环(CPB)下纠治术患儿的临床资料,利用二分类logistic回归模型分析先天性心脏病患儿CPB术后发生低体温的独立危险因素,应用R软件构建预测风险的列线图模型,通过ROC曲线评价模型的预测价值。结果研究期间711例患儿中术后发生低体温者239例(33.6%),男128例、女111例,中位年龄13.0个月(5.7~36.0个月)。二分类logistic回归分析结果显示,术前营养评分为高风险、禁食时间越长、CPB方案中转流温度越低、CPB停机温度<36℃是先天性心脏病患儿CPB复温后发生低体温的独立危险因素(P<0.05)。基于以上独立危险因素建立列线图模型,模型ROC曲线下面积(AUC)为0.887(95%CI:0.858~0.915)、约登指数为0.734、灵敏度为0.836、特异度为0.898。并对现有数据进行预测,总的预测准确度为79.8%,灵敏度为57.1%,特异度为90.9%。结论基于术前营养、禁食时间、CPB方案、体外停机温度4个独立危险因素构建的列线图模型具有较好的预测效能,在先天性心脏病患儿CPB复温后发生低体温预测中有较好的临床应用价值。
Objective To investigate the risk factors of hypothermia in children with congenital heart disease(CHD)after cardiopulmonary bypass(CPB)rewarming,and to establish an individualized linear model to predict the risk of postoperative hypothermia.Methods The clinical data of children with CHD who underwent CPB between January 1,2019 and April 30,2019 were retrospectively analyzed.The independent risk factors of hypothermia after CPB in children with CHD were analyzed by binary logistic regression model.The R software was used to construct the prediction risk nomogram,and the prediction efficiency of the model was evaluated by ROC curve.Results Among the 711 children,239 children(33.6%)met with hypothermia after surgery during the study period,including 128 boys and 111 girls,with a median age of 13 months(5.7-36 months).The results of binary logistic regression analysis showed that the preoperative high nutritional score,longer fasting time,lower CPB flow temperature and CPB shutdown temperature<36℃ were independent risk factors for hypothermia after CPB reheating(P<0.05).Based on the above independent risk factors,the nomogram model was established.The area under ROC curve(AUC)of the model was 0.887(95%CI:0.858~0.915),the Youden index was 0.734,the sensitivity was 0.836,and the specificity was 0.898.Based on existing data,the total prediction accuracy,sensitivity and specificity were 79.8%,57.1%and 90.9%respectively.Conclusions Based on the four independent risk factors of preoperative nutrition,fasting time,CPB regimen,and CPB shutdown temperature,the nomogram model has a good predictive performance,and has a good clinical application value in the prediction of unplanned hypothermia after CPB reheating in children with CHD.
作者
陈瑜
徐维虹
汪思园
CHEN Yu;XU Weihong;WANG Siyuan(Department of Anesthesiology,Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2021年第9期682-686,共5页
Journal of Clinical Pediatrics
基金
上海交通大学医学院科研项目(No.Jyhz803)。
关键词
先天性心脏病
体外循环
低体温
预测风险模型
列线图
congenital heart disease
cardiopulmonary bypass
hypothermia
predictive risk model
nomogram